Other projects are testing the effects of pharmacological and psychosocial treatments for youth with depression (aged 12-17 years). Going beyond the effects of treatment on symptoms of depression, this research also focuses on the impact of the interventions on functioning in school, at home, and in the community.

Effective Interventions for Delinquent Youth

It is important in evaluating interventions for delinquents to document what has not worked, as well as what has. For example, group-home approaches that pool delinquent youth together will, in some cases, exacerbate and escalate youth violence. Even promising interventions for delinquent youth can be overwhelmed by the negative effect of grouping such youth together.

This research finding has led to two highly successful treatment models for serious offending delinquents. One is multisystemic therapy (MST), in which specially trained therapists work with the youth and family in their home, with a particular focus on changing the peers with whom the youths associate. MST therapists identify strengths in the families and use these strengths to develop natural support systems and to improve parenting. Specific interventions are individualized to the family and address the needs of the child, family, school, peers, and neighborhood. Multiple, rigorous outcome evaluations have demonstrated the efficacy of this approach, and an independent cost-benefit analysis found that this model had a very high cost-benefit payoff. Although a number of states are now attempting to implement this model, the majority of programming for delinquent youth is based on models that bring together youth with problem behavior, rather than target separation of youth from problem peers.

The other model is Therapeutic Foster Care. This model offers a community-based intervention for serious and chronic offending delinquents. Therapeutic foster parents are carefully selected and supported with research-based procedures for working with serious and chronic delinquents in their homes. Treatment typically lasts 6 to 7 months. This intervention results in fewer runaways and fewer program failures than the usual placement in group homes is less expensive, and is dramatically more effective in reducing delinquency than traditional group homes. The Foster Family-based Treatment Association, developed under NIMH leadership, now has some 400 members across the U.S. who promote the use of this research-based and effective model.

Conclusion

As important as the problem of violence is, there will be no quick, inexpensive, and fail-safe solution. Recent years have witnessed a strong growth in our understanding of the risk factors and processes that contribute to and shape child and adolescent antisocial behavior. Yet gaps remain in our scientific understanding of how child, family, school/community, and peer factors interact, and which are the most appropriate targets for prevention and early intervention in different settings. We are also learning that being "at risk" does not doom any one child to become violent; conversely, the apparent absence of certain risk does not necessarily render any one child immune from problem behavior. The development of serious behavior problems is best understood as a dynamic interaction between child predispositions and various influences on children's lives (family, peer, and school/community) that change over critical periods of development.

Successful programs that produce long-term sustained effects may need to involve long-term intense interventions to target the multiple factors that can lead to negative outcomes such as family conflict, depression, social isolation, school failure, substance abuse, delinquency, and violence. The fundamental premise of some of these interventionsCwhich separate youth with problem behaviorsCchallenges the policies, programs and procedures that currently bring problem youth together. Continued research is needed to determine the most appropriate targets for prevention and early intervention that will produce lasting change. Answers are emerging about which programs are most successful, but assessments need to be made about their costs, as well as if they will work for all groups of children and adolescents.

The NIMH is committed to encouraging and supporting this research, and has a long and enduring history of support for research and research training on violence. Throughout the 1950s, and early '60s, NIMH provided research and research training support that built much of the modern field of behavioral science, and much subsequent research on violence has built upon that foundation. In 1966, NIMH created a Center for Studies of Crime and Delinquency, which was the locus of pioneering research on aggressive, antisocial, and violent behavior and its consequences. NIMH-supported research has generated information needed to identify, treat, and prevent not only the causes of violent behavior but also the effects of violence on victims, for example, child abuse.

next: Children and Violence