Program Profile: Methodist Home for Children's Value-Based Therapeutic Environment (VBTE) Model

This is a nonpunitive treatment model that concentrates on teaching juvenile justice–involved youth about prosocial behaviors as alternatives to antisocial behaviors. The program is rated Promising. Overall, findings were mixed. Treatment group youth had a statistically significant lower likelihood of being convicted for any new offense, compared with control group youth. However, there were no statistically significant effects on new charges or on incarceration rates.

A Promising rating implies that implementing the program may result in the intended outcome(s).

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

The Methodist Home for Children’s Value-Based Therapeutic Environment (VBTE) Model is a nonpunitive treatment model that concentrates on teaching juvenile justice–involved youth about prosocial behaviors as alternatives to antisocial behaviors. The VBTE Model is used in juvenile group homes operated by the Methodist Home for Children (MHC) in North Carolina. The MHC homes provide residential services for youth involved in the juvenile justice system who are referred for treatment through the state’s Department of Juvenile Justice and Delinquency Prevention (DJJDP).

To ensure a consistent approach in the treatment of youth, the VBTE Model provides a common set of values, skills, therapeutic activities, and intervention tools. In addition, an integrated approach is taken to individualized treatment plans for youth that incorporates parents, teachers, and court counselors.

Target Population/Eligibility

The target population is 10- to 18-year-old youth who are involved in the juvenile justice system. Youth must have been adjudicated delinquent and referred by the North Carolina DJJDP to receive residential treatment in one of the MHC juvenile homes.

Services Provided

The MHC VBTE Model has five treatment components:

1. Service planning, which provides a family and community approach to meet the needs of youths and their families
2. The skills curriculum, which provides staff with a teaching tool and promotes clear expectation and individualization for youth and their families
3. Learning theory, which promotes the understanding of individual youth and their behavior, which is critical to creating effective motivation systems
4. Motivation systems, which provide staff with a daily plan that supports the overall service plan, promotes therapeutic interactions, teaches and reinforces skills, and implements principles of the learning theory
5. Therapeutic (focused) interactions, which provide youth with structured teaching and reinforcement based on each individual’s service plan and learning levels, and incorporates the motivation system that is modified for each youth [Strom et al. 2010, 1–1]

The five components are designed to complement one another and concentrate on the treatment and services provided to youth and their families. The success of the VBTE Model relies heavily on the interactions between counselors and adjudicated youth. Counselors teach youth that their behavioral choices are related to six values: 1) respect, 2) responsibility, 3) spirituality, 4) compassion, 5) empowerment, and 6) honesty. Youth begin to appreciate and understand how their behavior affects those around them, and they receive consistent feedback from MHC staff about how to modify these behaviors.

Before they are admitted, all referred youth are screened through face-to-face meetings that include MHC staff and the youths’ families. For each youth who is admitted to the program, an individualized service plan is created based on information on the youth’s history in addition to input from his or her family, residential counselors, court-appointed counselors, and teachers. These specialized plans are developed within 14 days of admission and are updated every 30 days afterward. Service plan goals are also reviewed during treatment team meetings, which are held within 15 days of admission and every 30 days afterward.

In addition, each youth works with a family service specialist who performs needs assessments of the youth and his or her family at admission, prepares the youth for appearances in juvenile court, helps reintegrate the youth with his or her family and school when released, coordinates community services, and assists in the youth’s development of skills and appropriate behavior.

Study

Strom and colleagues (2010) used a retrospective quasi-experimental design to assess the impact of the Methodist Home for Children’s Value-Based Therapeutic Environment (VBTE) Model. Administrative data from the North Carolina juvenile justice and court system was used to create large pools of eligible treatment and comparison groups. Propensity scores were then generated to match juveniles who had received the VBTE Model (the treatment group) with similar juveniles who had not received the VBTE Model (the comparison group). Using this technique, the research team was able to match study-eligible non–Methodist Home for Children (MHC) subjects to study-eligible MHC subjects. A final study sample included 516 juveniles split evenly between the treatment and control group who received a level-2 disposition during the study period—Jan. 1, 2005, through June 20, 2008. In North Carolina, disposition levels are determined by the current or instant offense and by the individual’s delinquency history. For example, a level-2 disposition can result from the commission of a violent offense (for example, murder, rape, armed robbery) or a serious offense (e.g., drug possession, breaking and entering, aggravated assault). Minor offenses can also receive a level-2 disposition, but only if the person has several prior offenses (that is, a substantial delinquency history).

Because of the propensity-score matching technique, there were no significant differences between the treatment and control group on prestudy characteristics. The treatment group was predominately (80 percent) male, with an average age of 14.4 years. Treatment youth were 65.5 percent African American, 19.4 percent white, and 15.1 percent other races. The control group was also predominately (82.6 percent) male, with an average age of 14.4 years. Control youth were 65.9 percent African American, 17.4 percent white, and 16.7 percent other races. The treatment group consisted of juveniles who had resided in an MHC facility and received the VBTE Model. The comparison group consisted of juveniles similar to the treatment group in terms of key demographic information, criminal histories, and needs assessments, but they did not reside in an MHC or receive treatment similar to the VBTE Model. Each subject in the study was followed for a fixed 16-month period, starting after the court date that resulted in their inclusion in the study.

The overall study sample had multiple behavioral and delinquency issues. Ninety percent of subjects were assessed as having mental health care needs, and 87 percent of study subjects had been adjudicated delinquent at least once before their current adjudication. In addition, about half of the VBTE study subjects were adjudicated for a property crime as their most serious instant offense, and one third of study subjects were adjudicated for a person crime.

The key outcome variable was recidivism after the study court date. In this evaluation, five specific measures of recidivism were used:

1. A delinquent complaint filed with the North Carolina Department of Juvenile Justice and Delinquency Prevention
2. A new charge for a felony or misdemeanor offense filed in adult criminal court
3. A delinquent adjudication in juvenile court for a new offense
4. A conviction for a felony or misdemeanor offense
5. A commitment to a juvenile correctional facility

Most MHC participants were placed under court supervision for 12 months, referred to an MHC home within 2 months of their court date, and discharged from a home after about 5 months. This resulted in an average postprogram follow-up of about 9 months. Control group subjects typically were placed on court supervision for 11 months after their court date. Regression analyses were conducted to examine the differences in recidivism outcomes between the treatment youth and control youth. Further analyses separated youths into high- and low-risk categories based on their needs assessments. Subgroup analyses were conducted to examine the potential impact of risk level on outcomes. 

More information about the Methodist Home for Children and the Value-Based Therapeutic Environment (VBTE) Model is available online.

Subgroup Analysis

In addition to the overall effect of the intervention on the evaluation outcomes, Strom and colleagues (2010) analyzed whether the effect of the Methodist Home for Children’s Value-Based Therapeutic Environment (VBTE) Model varied by youth’ risk levels. Youth were categorized as having a low, medium, or high risk of recidivating. Of the youth in the VBTE treatment group, 37.6 percent were categorized as high-risk, 50.8 percent as medium-risk, and 11.6 percent as low-risk. In the control group, 34.1 percent of the youth were categorized as high-risk, 55.0 percent as medium-risk, and 10.8 percent as low-risk.

The subgroup analysis showed that high-risk youth in the VBTE treatment group had a statistically significant lower recidivism rate compared with high-risk youth in the comparison group (57.7 percent versus 71.6 percent, respectively). There was also a statistically significant lower number of high-risk youth in the VBTE treatment group who were incarcerated for a recidivist offense, compared with the control group youth (10.5 percent versus 35.3 percent, respectively). The high-risk youth in the VBTE treatment group also had a statistically significant lower number of misdemeanor charges and person charges, compared with the control group. However, there were no statistically significant differences in felony, property, drug, or public disorder charges.

Finally, the subgroup analysis showed there were no statistically significant differences on any outcomes when comparing the low-risk and medium-risk youth in the VBTE treatment group with the control group.

These sources were used in the development of the program profile: