E¡ectiveness of a Dialectical Behaviour Therapy Program for Incarcerated Female Juvenile O¡enders EricW.Trupin 1 , David G. Stewart 1 , Brad Beach 2 & Lisa Boesky 1 1 University of Washington, Department of Psychiatry and Behavioral Sciences, 146 N. Canal Street, Suite 100, Seattle, WA 98103, USA 2 Echo Glen Children’s Center, 33010 SE 99th Street, Snoqualmie, WA 98065, USA Background: Female offenders incarcerated in Washington State have demonstrated higher rates of mental health needs than boys. Linehan’s (1993a, b) Dialectical Behavioural Therapy (DBT) is an effective treatment for adult women with Borderline Personality Disorder. DBT utilises a combination of skills training, problem solving, and validation to enable patients to reduce self-destructive, impulsive and aggressive behaviours. The prevalence of similar emotional problems among female juvenile offenders suggests that DBT may be an effective strategy for this population. The State of Washington Governor’s Juvenile Justice Advisory Committee sponsored a collaborative project conducted by a research team from the University of Wash- ington and the staff at the Juvenile Rehabilitation Administration’s Echo Glen Children’s Center to evaluate the effectiveness of a DBT intervention. Method: Pre-post intervention records were compared for female offenders from a mental health and a general population unit where DBT was implemented. Youth on a third unit served as a comparison group. Youth behaviour problems, staff punitive responses were compared before and after the intervention period. Results: Youth behaviour problems and use of punitive responses by staff decreased compared to the year prior on one cottage (unit) while no behaviour or staff changes were noted on another. Conclusions: The evaluation demonstrated the efficacy of providing DBT to female offenders in a residential setting and yielded mixed results on behaviour change during the study period that may relate to quality of training and prior youth behaviour problems. Keywords: Juvenile justice; mental health; juvenile offenders Introduction In the United States the juvenile justice system has multiple and at times conflicting responsibilities. These include holding a youth accountable for their delin- quent behaviour, punishing a youth for breaking the law, keeping a youth out of a community to prevent further criminal behaviour and providing rehabilitation so the youth will learn pro-social behaviours inconsis- tent with criminal activities. Accountability, punish- ment, deterrence, restoration, public safety, and rehabilitation are the core obligations of juvenile jus- tice. The system was not designed to provide compre- hensive treatment for youth with mental health and substance abuse disorders. However, over the past two decades there has been a steady and significant increase of youth exhibiting major psychiatric disorders who come into contact with the juvenile justice system. Numerous studies have demonstrated that at least 20% of all youth entering the justice system exhibit serious mental or emotional problems, with the majority also experiencing a co- occurring substance use disorder (Otto et al., 1992; Loeber & Farrington, 1998; Stewart & Trupin, 2000). The so-called ‘tough on crime’ policies adopted by state and federal legislatures in the 1980s have lead to a major increase in mandatory sentences of youth to de- tention facilities. Juvenile judges’ previous capacity to use discretion in sentencing seriously disturbed youth to community-based treatment was significantly reduced. In many communities access to community mental health services for youth who are minorities, have both mental health and substance use disorders, and have delinquent histories were and are non exist- ent. Thus, even in circumstances where diversion to community placements are within the purview of a judge, they often justify sentencing these youth to se- cure detention facilities just so they can receive mental health services. Mental health issues among female juvenile offenders A large proportion of juvenile offenders have serious emotional disturbances (Elliot, Huizinga, & Menard, 1989; Loeber, Wung, & Keenan, 1993). Although con- duct disorders appear to be the most prominent diag- noses among youth in juvenile justice settings, studies have shown the prevalence of affective disorders, including major depression, bipolar disorder, dysthymia, and cyclothymia to range from 32 to 78% (McManus et al., 1984; Wierson, Forehand, & Frame, 1992; Edens & Otto, 1997). As many as 70% may have substance Child and Adolescent Mental Health Volume 7, No. 3, 2002, pp. 121–127 Ó 2002 Association for Child Psychology and Psychiatry. Published by Blackwell Publishers, 108 Cowley Road, Oxford OX4 1JF, UK and 350 Main Street, Malden, MA 02148, USA