The Juvenile Delinquent Jamie - Case Study Example

Adolescent Case Study Introduction Different situations in patient care may call on different methods and applications of care. In health care, each patient is different from another, requiring care which is often based on his individual illness and his individual stage in the biological process. An infant who is sick with the flu often requires a different type of care from an elderly patient with flu. Each patient and each case has a different critical issue which would likely impact on the type of care administered to him by the members of the health care team. This paper shall be a case study of Jamie, a 14 year old adolescent male who has been arrested for attempted robbery. Jamie is currently enrolled as a second year high school student; however, he is often truant. When he does attend school, he is frequently arguing with his teachers. It is noted however, that during his primary school years, he was actually performing well in his studies. He also got on well with his physical education teacher. According to his parents, he used to be a very active child but he had difficulty concentrating in school. Based on the MAYSI assessment, clinical elevations were apparent on the Depressed-Anxious and Suicide Ideation Subscale. He had one previous offence of stealing, about 12 months ago. This incident was also accompanied by substance abuse and in the company of peers. Jamie first smoked cannabis at the age of 13 and he started inhaling paint approximately 3 months ago. At present, he smokes cannabis several times a week with friends. His paint use is sporadic, every couple of weeks. His offending behaviour enables him to distance himself from his parents. Coincidentally, his behaviour has managed to force his parents, who were previously estranged, to work together to solve the problems associated with their child’s juvenile delinquency. Considering the above case, the critical issues of this case study shall first be identified. Next, how these issues specifically impact and or disadvantage the adolescent shall also be identified. Then, this paper shall use research literature in order to discuss whether there is an argument for implementing specific strategies to mitigate the impact of disadvantages which might be experienced by the adolescent. Discussion Critical issues The critical issues in the case study mostly involve Jamie’s activities which come under the purview of juvenile delinquent behaviour. Such behaviour includes his truancy, substance abuse, and his stealing. Other issues involve his difficulty in concentrating in school, his depression and suicidal ideation, and the fact that his parents are estranged. His parents’ estrangement, despite the fact that they are somehow presenting a more concerted effort to help Jamie, is still an issue because Jamie’s issues manifested during the estrangement of his parents. His parents’ estrangement has still impacted on his current issues. Impact and disadvantages of juvenile delinquency on adolescents The issues of juvenile delinquency which Jamie is manifesting impact on his life by possibly landing him in juvenile detention and causing him to lose his freedom. Being incarcerated can cost the adolescent the time and opportunity for education and the chance to enjoy relatively healthy relations with other people, including his family (Barker, 2010). A study by Huizinga, et.al., (2004) reveals that delinquency more or less puts these adolescents under a cloud of suspicion throughout their lives. Being known to the police with previous arrest records only increases the probability of future arrest (Huizinga, et.al., 2004). Being arrested and later incarcerated can increase the risk of crime commission. “The act of incarcerating high numbers of youth may in fact facilitate increased crime by aggravating the recidivism of youth who are detained” (Holman & Ziedenberg, n.d., p. 4). Studies were able to establish that 70% of youth who were incarcerated were often returned to detention within a year after their release. These studies further claim that the detention may deter some juveniles from committing more crimes, however, it does not deter most delinquents. As they spend time away from their families and from a life which would have been normal for other adolescents their age, they are instead being exposed to criminal elements in jail. These elements may include gangs, drug use and abuse, and other violent activities in the jails. When they are released, they are hardly rehabilitated and are prone to be involved in more criminal activities – most of the times, escalating to more complicated crimes. Jamie’s involvement in these criminal activities also puts him at risk for being tried as an adult. If his activities persist until he reaches the age of 15 and onwards, he may very well be tried under some jurisdictions as an adult. This will further represent lost opportunities to make a better life for himself and even for his family. These juveniles may also lose ground academically (Barker, 2010). These adolescents’ delinquent activities take them away from school and their academic activities. Lost time in school also means delayed academic learning. In many cases, the delinquent activities of adolescents also lead to activities which compromise their education. Many of these adolescents skip school, engage in violent activities, are involved in property crimes, and often use drugs (Tanner, Davies & O’Grady, 1999). These behaviours are already manifesting in Jamie as his delinquency is already causing such behaviour. Moreover, the cycle of delinquency is being repeated over time. A study conducted in order to determine the effects of delinquency on the adolescent was able to establish that delinquency manifests with negative effects on the educational attainment of adolescents, most especially males (Tanner, Davies, & O’Grady, 1999). The education attainment of these delinquent adolescents is often reduced due to their delinquent behaviour. The consequences are especially harsh and heavy on adolescent males. There are more delinquent activities they can engage in and the vulnerability of the machismo mentality of the adolescent often gets these young men into more delinquent activities. Among these males, the mentality involved in going to school is that it is ‘uncool.’ Hence, we often see celebrity endorsers push the mantra ‘Be cool, stay in school’ in television spots or commercials. This mantra is often meant to influence these adolescents – especially those engaging in deviant activities – to indeed, ‘stay in school.’ It is important to note that the status of “non-attainment stems from the deleterious effects that deviance has upon educational performance, though some is directly attributable to that deviant activity” (Tanner, Davies, & O’Grady, 1999, p. 20). There is an accepted culture among adolescents – that if delinquency is prevented at a very early age then it can inoculate these adolescents against the possibility of getting involved in mild or severe wrong-doings (Tanner, Davies, & O’Grady, 1999). Eventually, as these adolescents are introduced into the labour market, they carry the disadvantage of being formerly incarcerated and not having the necessary academic qualifications for gainful employment. “Delinquency may foster poor work skills, limit social networks, or bring on the effects of labelling and stigmatizing” (Tanner, Davies & O’Grady, 1999). Granting that the law has already made provisions which prevent discrimination in the workplace, most of the hiring and firing process is still within the discretion of managers. If they feel that a former juvenile delinquent is unemployable in their company, they can come up with different reasons for not hiring the former delinquent. This may be the case for Jamie in the near future. He has displayed delinquent characteristics which are negative points against him for future employment. A study by Dishion, Loeber, Stouthamer-Loeber and Patterson (2005) was able to establish that antisocial adolescents often lack academic, interpersonal, and work skills. They were able to relate these results with delinquency and they were also able to establish that youths who were designated as delinquents based on previous police contact had lower rates of performance in the academic, interpersonal and work skills (Dishion, Loeber, Stouthamer-Louber, & Patterson (2005). Again, the results of this study are already apparent in Jamie’s case as he is manifesting compromised academic performance and interpersonal skills with other children his age and with his parents. The effects of his delinquency on his work skills would be apparent in his future. But the danger signs are already manifesting, and if no effective interventions are implemented in his favour, then, Jamie would be unemployable and would be an even greater risk to himself and to society. There is also a danger that Jamie’s behaviour would result to private conflict with his parents and care-givers at his home; and also public confrontations with his teachers in school. Confrontations with teachers have already been manifest in Jamie’s life (Tanner, Davies, & O’Grady, 1999). And even if Jamie’s behaviour requires adequate counselling as a proper intervention, the implementation of punitive punishment may still be seen. Punitive punishments would also not serve Jamie well because it further introduces him to violence and opens him to feelings of embarrassment and shame (Tanner, Davies, & O’Grady, 1999). Public confrontations labels and marks him as a delinquent and it is a label which not many people are able to escape or relinquish. Impact of Depression/Suicidal Ideation of adolescents Most adolescents are not aware that their depression is the cause of the emotional changes they are going through in their life, including their ability to interact with other people and their poor performance in school (Bonin, 2010). These changes put them at great risk for more depressive episodes which grow even worse when untreated. They are also at risk for the following: difficulties in their school work and in their relationships with parents and their friends; decreased interest in daily activities; health complaints including abdominal pain, fatigue, and headaches; engaging in high-risk behaviours like having sex, smoking, drug abuse, alcohol abuse, violence against others, and suicide attempts (Bonin, 2010). In Jamie’s case, as was mentioned, he displays many of the qualities as seen in depressed adolescents. And his suicidal ideation should be treated seriously and as a primary consideration in his care. Impact of difficulties in concentrating in school work Adolescents with difficulties in concentrating in school work are often actually bright and creative students; however, their emotional issues are the ones which are causing them to underperform in their school subjects. They can often create confusion among the parents and teachers because they perform well in some areas and underperform in others (CRC Health Group, n.d). And when the adolescents’ emotional problems and capabilities are not understood by their parents and teachers, they often fall prey to the dangers of juvenile delinquency. This is clearly the case for Jamie. He has emotional issues which may stem from his parents’ estrangement and his feelings of depression. And these feelings clearly affect his current difficulties in concentrating in school. He has performed well during his primary education, but he now has trouble concentrating on his studies. Clearly, there is a need to address these issues before they manifest greater effects on his future. Strategies for specific interventions There are specific interventions which can help address the specific problems which Jamie is experiencing. One of these strategies is the multisystemic therapy or MST. This therapy is “a highly-individualised family-and-home-based treatment that has successfully served as a clinically effective and cost-effective alternative to out-of-home placements (eg. Incarceration, psychiatric hospitalization for youth presenting serious clinical problems)” (Rowland, et.al., 2000, p. 30). The MST allows for a comprehensive assessment and intervention to be implemented for the adolescent. And in the case of Jamie, his issue is certainly one which merits a multisystemic therapy. The study by Rowland, et.al. (2000) was able to point out that in order to change the issues among adolescents, therapists must be able to implement interventions to specific individuals, groups (family and peers), and systems like schools and neighbourhood which affect the problem. For interventions to be effective, these interventions have to be implemented within the natural environment of the family and the adolescent. Hence, it is outside the prison system and psychiatric hospitalization. Instead, for most cases it is home-based and it involves the entire family (Rowland, et.al., 2000). Jamie is having mental health problems associated with his depression and suicidal ideation; he is also having problems in school and in his academic performance; he is also displaying criminal behaviour. All these elements affect each other, either as the cause or the effect of his problems. The MST includes all the possible elements involved in Jamie’s issues and problems and they attempt to address such issues within the context of Jamie’s home and comfort zone. In a paper by Henggeler, Melton, & Smith (1992), the authors set out to compare the MST delivered through a community health centre and the usual services which were delivered by the Department of Youth Services in treating juvenile delinquents and their families. The offenders were assigned based on treatment conditions (Henggeler, Melton, & Smith, 1992). Assessment before and after treatment was conducted based on family relations, peers, symptoms, social relations, and self-reported delinquency covering youth and parents (Henggeler, Melton, & Smith, 1992). Archived records were also searched at 59 weeks postreferral in order to assess data on repeated arrests. The study revealed that youths who were subjected to MST had fewer arrests and self-reported offenses as compared to youths who received the usual services given by the Department of Youth Services (Henggeler, Melton, & Smith, 1992). The families of individuals under MST also registered stronger family cohesion and lesser youth aggression in peer relations (Henggeler, Melton, & Smith, 1992). This study demonstrates how specific strategies can mitigate the impact of issues which a delinquent adolescent may experience. The MST covers not just one aspect of a patient’s issues and problems, but it also covers other aspects which may contribute to his problems. Moreover, the implementation of the interventions works well under the settings of the family and the community – not the restrictive incarceration system. In yet another study on MST, Henggeler, Pickrel, and Brondino (2004) sought to assess its effectiveness and transportability on 118 juvenile offenders who met the criteria for DSM-III-R criteria for substance abuse of dependence and the effect of such problems on their families. The respondents were grouped to receive either MST or the usual community services for juvenile delinquents. The study assessed the respondents based on drug use, criminal activity, and number of days in out-of-home placement at posttreatment and 6 months after posttreatment (Henggeler, Pickrel & Brondino, 2004). The authors also evaluated the adherence to treatment from the perspective of caregivers, the youth, and the therapist). The study was able to establish that MST decreased alcohol, marijuana, and other drug use 6 months after posttreatment; it was also able to reduce the number of days of the adolescent in out-of-home placement by 50% (Henggeler, Pickrel, & Brondino, 2004). Decrease in criminal activity however was minimal. The authors speculated that these modest results were due partly to difficulties encountered relaying the complicated treatment model from the control of its developers (Henggeler, Picker, & Brondino, 2004). A similar study was conducted by Borduin, et.al., (1995) who sought to compare the long-term effects of the multisystemic therapy and individual therapy in the prevention of criminal behaviour and violent offending among 176 juvenile delinquents who were also at high risk for committing serious crimes. Assessment batteries before and after treatment indicated that MST was more effective than individual treatment in improving the main family factors relating to anti-social behaviour and in improving adjustment problems in the members of the family (Borduin, et.al., 1995). Also, based on a 4-year follow-up of rearrest data, it was apparent that the MST was more effective than individual therapy in minimizing future criminal behaviour. The risk for the commission of violent offenses was also decreased by the MST (Borduin, et.al., 1995). Huey, Henggeler, Brondino, and Pickrel (2000) also sought to determine how the mechanisms of change in MST worked, how they reduced delinquent behaviour through therapist adherence and enhanced family and social functioning. The study covered 2 groups of juvenile delinquents with the first group including serious offenders who were mostly rural, male, and African-American and the second group being substance abusers who were mostly urban, male, and Caucasian (Huey, et.al., 2000). The study revealed that with improved family relations, there was decreased peer affiliation, and consequently, decreased delinquent behaviour. The study was able to emphasize the importance of identifying central change mechanisms in determining how complicated treatments like MST can actually present better outcomes for the patient and for his family (Huey, et.al., 2000). The more a patient spends with his family, the less time he spends with his peers, and eventually, the less he can be steered into criminal offenses. The effectiveness of the MST on adolescents with mental health problems, including antisocial behaviour and depression was assessed in a study by Henggeler, et.al., (1999). The study assessed symptomatology, antisocial behaviour, self-esteem, family relations, peer relations, school attendance, and consumer satisfaction 3 times in a 24-hour period shortly after the adolescent was released from a mental health institution and after completion of MST for 6 months (Henggeler, et.al., 1999). The study revealed that the MST was far more effective than hospitalization in decreasing the adolescents’ externalizing symptoms, and in improving the youths’ family relations and school attendance (Henggeler, et.al., 1999). The satisfaction of patients and their families was higher when the patient was under the MST. Based on these results, the authors pointed out that an intensive and well-specified treatment model which is family and community-based is far more effective that psychiatric hospitalizations of children and adolescents (Henggeler, et.al., 1999). Literature also suggests that in some instances, functional family therapy is also an effective therapy for juvenile delinquents and their families. A paper by Gordon, Arbuthnot, Gustafson, and McGreen (1979) assessed the effects of the application of the family therapy model for lower socioeconomic status juvenile offenders, with multiple offenses, plus misdemeanours and felonies. Twenty-seven delinquents who were assigned to home or out-of-home placement therapy were included in this paper and were compared to 27 lower risk delinquents (Gordon, et.al., 1979). The evaluation was based on the number and severity of offences in the 2 ½ years following the initial grouping. The study was able to reveal that those participants receiving family therapy had a lower recidivism rate as compared to the group receiving out-of-home placement therapy. Through this study, it can be deduced that family has a crucial role in minimizing the incidents of juvenile delinquency and minimizing the impact of such issues on an adolescent’s life. A 2004 paper by Liddle sought to describe the development status of the family-based adolescent alcohol and drug treatment specialty through the identification of research and clinical advances. The paper used selective and interpretative literature review and analysis to assess the available reports. The review was able to establish that family based interventions usually included development therapy, training, and supervision (Liddle, 2004). Different models for family therapy have been assessed based on their success in controlled trials and studies. The results indicated strong support for alternative interventions to incarceration and hospitalization-based therapies (Liddle, 2004). The family-based therapies also created stable outcomes for adolescents and they indicate a significant decrease in target symptoms and alcohol/drug use, including other delinquent behaviour. Moreover, “improvements in family interaction patterns coincide with decreases in core target alcohol and drug misuse” (Liddle, 2004, p. 76). This study again points out the importance of a family-based therapy for adolescents. For adolescents, support from the family can sometimes make or break them. And with such support, these adolescents are able to thrive and be more focused in their goals to improve their attitudes and their general outcomes. The importance of applying a multidimensional therapy in cases of juvenile delinquency was emphasized in a study by Liddle, Dakof, Parker, Diamond, Barrett, and Tejeda (2001). In their paper, they randomly assigned 182 clinically referred marijuana and alcohol abusing adolescents to one of the following: the multidimensional family therapy (MDTF), adolescent group therapy (AGT), and the multifamily educational intervention (MEI) (Liddle, et.al., 2001). The therapies were delivered through a manual once a week and outpatient basis by experienced therapists. The study was able to reveal that improvements were actually seen among all the youths included in this study – in all three treatments, with the MDFT showing the most improvement of all three groups (Liddle, et.al., 2001). The MDFT participants also registered with the most change after the 1-year follow up period considering ratings like school/academic performance and family functioning. The paper was able to emphasize the effectiveness of the MDFT and family-based interventions in reducing juvenile delinquency, especially drug use. Conclusion This is the case study of the juvenile delinquent, Jamie. Issues surrounding Jamie include his delinquent behaviour like his truancy, drug use and abuse, and his stealing. Other issues also include his depression, suicidal ideation and his difficulty in concentrating in school. These issues cause different disadvantages for him. First and foremost, his delinquent behaviour puts him in danger of imprisonment of incarceration. Such incarceration can exacerbate his delinquency and expose him to other criminal activities which can later cause him to be a repeat offender. His imprisonment can also put him at risk of being punished as an adult for his criminal activities, now or possibly in the future. He can also lose ground academically because of his delinquent behaviour. His issues of depression can also cause him to participate in more criminal activities. His difficulties in concentrating in school can also cause him to be more delinquent in his activities. Specific interventions applicable to his needs include the multisystemic therapy, which targets various problems at one time; family-based therapy can effectively include the family in the therapy, thereby helping to engage the adolescents’ approval and to gain for him, the much-needed support he deserves. Works Cited Barker, L. (2010) The Effects of Juvenile Delinquency. eHow. Retrieved 03 May 2010 from http://www.ehow.com/about_5108646_effects-juvenile-delinquency.html Bonin, L. (2010) Patient information: Depression in adolescents. Up To Date. Retrieved 03 may 2010 from http://www.uptodate.com/patients/content/topic.do?topicKey=~/O/trvd9NTY_/ Borduin, C., Mann, B., Cone, L., Henggeler, S., Fucci, B., Blaske, D. & Williams, R. (August 1995) Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63(4), pp. 569-578. CRC Health Group (n.d) Learning Disabilities. 4 Troubled Teens. Retrieved 03 May 2010 from http://www.4troubledteens.com/learning-disabilities.html Dishion, T., Loeber, R., Stouthamer-Loeber, M., & Patterson, G. (2005) Skill deficits and male adolescent delinquency. Journal of Abnormal Child Psychology, 12(1), pp. 1573-2835 Gordon, D., Arbuthnot, J., Gustafson, K., & McGreen, P. (1979) Home-based behavioral-systems family therapy with disadvantaged juvenile delinquents. The American Journal of Family Therapy, 16(3), pp. 243 - 255 Henggeler, S., Melton, G., & Smith, L. (1992) Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders. Journal of Consulting and Clinical Psychology, 60(6), 953-961 Henggeler, S., Pickrel, S., & Brondino, M. (2004) Multisystemic Treatment of Substance-Abusing and -Dependent Delinquents: Outcomes, Treatment Fidelity, and Transportability. Mental Health Services Research, 1(3), pp. 1573-6636 Henggeler, S., Rowland, M., Randall, J., Ward, D., Pickrel, S., Cunningham, P., Zealberg, J. (November 1999) Home-Based Multisystemic Therapy as an Alternative to the Hospitalization of Youths in Psychiatric Crisis. Journal of the American Academy of Child and Adolescent Psychiatry, 38(11), pp. 1331-1339 Holman, B. & Ziedenberg, J. (n.d) The Dangers of Detention: The Impact of Incarcerating Youth in Detention and Other Secure Facilities. CFJJ. Retrieved 03 May 2010 from http://www.cfjj.org/Pdf/116-JPI008-DOD_Report.pdf Huey, S., Henggeler, S., Brondino, M., & Pickrel, S., (June 2000) Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning. Journal of Consulting and Clinical Psychology, 68(3), pp. 451-467. Huizinga, D., Schumann, K., Ehret, B., Elliott, A. (April 2004) The Effect of Juvenile Justice System Processing on Subsequent Delinquent and Criminal Behavior: A Cross-National Study. U.S. Department of Justice. Retrieved 03 May 2010 from http://www.ncjrs.gov/pdffiles1/nij/grants/205001.pdf Liddle, H. (2004) Family-based therapies for adolescent alcohol and drug use: research contributions and future research needs. Society for the Study of Addiction (Suppl. 2), pp. 76–92. Retrieved 03 May 2010 from http://www.med.miami.edu/ctrada/documents/Liddle_2004.pdf Liddle, H., Dakof, G., Parker, K., Diamond, G., Barrett, K., & Tejeda, M. (2001) Multidimensional Family Therapy for Adolescent Drug Abuse: Results of a Randomized Clinical Trial. The American Journal of Drug and Alcohol Abuse, 27(4) pp. 651 – 688 Rowland, M., Henggeler, S., Gordon, A., Pickrel, S., Cunningham, P., & Edwards, J. (2000) Adapting Multisystemic Therapy for Serve Youth Presenting Psychiatric Emergencies: Two Case Studies. Clinical Psychology & Psychiatry Review, 5(1), pp. 30-42 Tanner, J., Davies, S. & O’Grady, B. (1999) Whatever Happened to Yesterday’s Rebels? Longitudinal Effects of Youth Delinquency on Education and Employment. WALL Working Paper No. 5. Retrieved 03 May 2010 from https://tspace.library.utoronto.ca/bitstream/1807/2719/2/05rebels.pdf Read More