Program Profile: Risk Detection/Executive Function Intervention

This is a program for adolescent females with a history of violence/abuse and involvement in the child welfare system. The goal of the program was to reduce re-victimization in teen dating situations. The program used mindfulness-based, cognitive interventions to build skills for responding to risky situations (including reasoning and problem solving). The program is rated Promising. The intervention was shown to statistically significantly reduce sexual and physical re-victimization.

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 Risk Detection/Executive Function (RD/EF) program set out to reduce sexual and physical re-victimization in girls who had previously been exposed to maltreatment. Research has found that youths with histories of re-victimization have impaired abilities to detect threats or risky situations in intimate relationships (an ability known as risk detection [RD]). Research has also shown an important link between youths who experience child abuse and deficits in executive function (EF). EF refers to those cognitive skills that allow an individual to respond to risks of danger in a relationship (DePrince et al. 2013). Based on this research, the RD/EF intervention not only focused on improving girls’ ability to perceive risky and dangerous situations, but also on improving their ability to respond to those situations. 

Target Population/Eligibility

The RD/EF program focused on adolescent females between the ages of 12–19. The participants were referred to the program (by their caseworkers, service providers, or legal guardians) because they were currently or previously involved with the child welfare system and had a history of maltreatment exposure. They were also eligible for the study if they 1) did not report current suicidal ideation; 2) were receiving current treatment services for reported suicide attempts or psychiatric hospitalizations within the last 3 to 6 months; and 3) were receiving current treatment services for reported self-harm behavior or psychosis (DePrince et al. 2013).

Program Theory

Risk detection (RD) requires that an individual notice and respond to danger cues (both external, such as a dating partner’s threatening behaviors, and internal, such as one’s own feelings of fear or discomfort) in intimate relationships (DePrince 2006). A range of cognitive skills, called executive functions (EFs), are required for one to notice and respond to danger cues. These skills include the ability to shift, inhibit, and focus attention; maintain focus in the face of distracting information; update new information to the working memory system; think flexibly about potential solutions; and plan and initiate actions (DePrince et al. 2013, p. 14). In potentially dangerous situations, teens with compromised EF, due to previous victimization, may have trouble noticing potential danger cues and may not be able to figure out how to respond to threats. The authors theorized that teaching teens the EF skills needed to notice and respond to danger cues would result in decreased re-victimization. 

Program Activities

To create the Risk Detection/Executive Function intervention, DePrince and colleagues (2013) modified a risk detection program, which had been developed by Marx and colleagues (2001) for college students. Additionally, they adapted a mindfulness-based intervention, originally developed by DePrince and Shirk (2013), to target alterations in executive functioning. They integrated the mindfulness-based program with Marx’s risk detection curriculum and made it age-appropriate and engaging.

The program was implemented outside of school, in a community-based location, and included 12 sessions, each with a detailed session theme. The sessions each lasted 1.5 hours and were provided weekly. Using mindfulness-based, cognitive interventions, the program helped adolescents become more aware of both internal (e.g., feelings of shame, fear) and external (e.g., a partner’s threatening behaviors or the presence of nearby danger) cues for risky situations and ways to respond to risks. Sessions included the following:

1. Introduction to the group (meeting other members, establishing rules)
2. Consequences of violence/abuse: Going on auto-pilot
3. What is violence and aggression?
4. Getting on active pilot: Noticing the world around us
5. Getting on active pilot: Noticing our bodies and physical sensations as guides
6. Getting on active pilot: Noticing our thoughts as guides
7. Getting on active pilot: Noticing our reactions as guides
8. Active pilot in dating situations: What is risky?
9. Responding to risk: Figuring out what to do
10. Responding to risk: Knowing what to do and asserting what I want
11. Responding to risk: Knowing where to get help
12. End of group celebration 

Key Personnel

Two co-facilitators covered the content of the program, using the program manuals. The co-facilitators were graduate-level trainees and received weekly supervision from the program developer.  The program developer also served as a co-facilitator.

Study

DePrince and colleagues (2013) used a quasi-experimental design study to assess the effects of the Risk Detection/Executive Function (RD/EF) intervention on physical and sexual re-victimization. The program took place in Denver and the surrounding areas. Adolescent girls between 12 and 19 were referred to participate in the Healthy Adolescent Relationship Project (HARP) by their caseworkers, foster parents, or service providers. Referred adolescents were assessed prior to being randomized into a treatment condition. Eligible participants were randomly assigned into two different treatment groups (i.e., the RD/EF intervention, described here, and the Social Learning/Feminist intervention, described in a separate program description).The sample also comprised a non-random comparison group of eligible individuals who did not participate in either group. 

There were no significant pre-treatment differences between the groups. The RD/EF group consisted of 67 adolescent girls. Of the 57 girls who shared race data, 42 percent were white, 31 percent were Black, 2 percent were Asian/Asian American, 11 percent were American Indian/Native Alaskan/Native American, and 14 percent were other races. The comparison group consisted of 42 individuals, 34 of whom provided race information. The comparison group was 35 percent white, 32 percent Black, 3 percent Asian/Asian American, 6 percent American Indian/Native Alaskan/Native American, 21 percent other races, and 3 percent unknown (declined to answer).

Participants in the study engaged in four, 2-hour assessments. These occurred prior to the intervention (Time 1), immediately after the intervention (Time 2), and again 2 and 6  months after the intervention (Times 3 and 4). The presence/absence of re-victimization was measured using a combination of data gathered from The Traumatic Events Screening Inventory-Child Version (TESI), which gauged previous trauma exposure, and the Conflict in Adolescent Dating Relationship Inventory (CADRI), which assessed dating violence. Linear contrast analysis on estimates from a repeated measures, generalized estimating equation (GEE) approach was used to determine the effects of the program on sexual and physical re-victimization in Times 2, 3, and 4.

DePrince and colleagues (2013) developed a checklist to assess fidelity to the Risk Detection/Executive Function intervention curricula.

For example, for Session 3 (“What is violence and aggression?”), implementation should include a mindfulness exercise and the session should cover facts about violence against women, personal rights, and the connection from personal rights to attention.

Further examples of specific items assessed in the checklist are provided in the original report, available at https://www.ojp.gov/pdffiles1/nij/grants/244086.pdf.

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

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

DePrince, Anne P. 2006. “Cognitive Correlates of Trauma Exposure.” Paper presented at the Neuroscience Research Group, University of Denver, Denver, Colo.

DePrince, Anne P., and Stephen R. Shirk. 2013. “Adapting Cognitive-Behavioral Therapy for Depressed Adolescents Exposed to Interpersonal Trauma: A Case Study With Two Teens.” Cognitive and Behavioral Practice, 20, 198–201.

Marx, B.P., K.S. Calhoun, A.E. Wilson, and L.A. Meyerson. 2001. “Sexual Revictimization Prevention: An Outcome Evaluation.” Journal of Consulting and Clinical Psychology, 69, 25–32.

Following are CrimeSolutions-rated programs that are related to this practice:

Programs to Reduce Dating and Sexual Violence for Youth and Young Adults

This practice involves a range of prevention and intervention programs that are designed to address problems associated with dating violence for youth and young adults. The practice is rated Effective for reducing the perpetration of dating violence and improving dating violence knowledge and attitudes. The practice is rated Ineffective for reducing dating and sexual violence victimization, reducing sexual violence perpetration, and for improving bystander behaviors.

Evidence Ratings for Outcomes

	Attitudes & Beliefs - Dating violence knowledge
	Attitudes & Beliefs - Dating violence attitudes
	Crime & Delinquency - Violent offenses
	Victimization - Bystander behavior and intentions
	Crime & Delinquency - Sex-related offenses
	Victimization - Sexual abuse/exploitation
	Victimization - Domestic/intimate partner/family violence

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?