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Follow-up of stealing behavior in 27 youths after a variety of treatment programs
3. Behov. Thu. &Erp. Psychial. Printed in Great Britain.
Vol. 14, No. 4, pp. 331-337,
oMl5-7916/83 s3.00+ .I0 0 1983 Pcrgamon Press Ltd.
1983.
FOLLOW-UP OF STEALING BEHAVIOR IN 27 YOUTHS AFTER A VARIETY OF TREATMENT PROGRAMS JOHN Q. HENDERSON Psychological Service, Department of Education, Dunedin, New Zealand Summary-Case histories are presented of 27 youngsters who had a major problem of stealing. The effectiveness of eight different treatments is examined in terms of proportion of follow-up time spent stealing. (Durationof follow-up was always more than 2 yr.) Clients given Individualized Combined Treatment spent 295% of follow-up time stealing, compared with 46% after other types of treatment.
Parents of children who steal suffer considerable anguish, and most will try every conceivable technique to stop the stealing. Despite this, the treatment of theft has received very little experimental attention from researchers (West, 1974; Stumphauser, 1976). Long-term followup evaluations are rare and those which have been done generally show that remedial and rehabilitation attempts have little or no effect (Jeffery, 1967; Azrin and Weslowski, 1974). The importance of long-term follow-up is indicated by a New Zealand study of 142 boys who had attended a Correction Centre and who had a cumulative yearly recidivism rate of 60, 75, 85, 90 and 91% over 5 yr (Department of Social Welfare, 1973). Extreme difficulty in finding successful interventions for stealing is suggested by Moore, Chamberlain and Mukai (1979) who found that even the “social 1earning”approach used so successfully by Reid and Patterson (1976) with aggressive children was relatively ineffective for stealing. Of the 25 children whose main presenting problem was stealing, 77% later had court recorded nonstatus offences (e.g. burglary, assault) compared with 13Vo of the aggressive children and 21% of the normative group. The present study involved a follow-up of 27 children and young persons, all of whom had
been referred to child psychological services, and for all of whom at least one referral had been because of stealing. Within the one clinic these children had received a variety of treatments at different times from different psychologists. Ten of the children had at some stage been given Individualized Combined Treatment, the behavioral approach to stealing reported by Henderson (1981). The effectiveness of different treatments is usually assessed by comparing the recidivism rate of differently treated groups. However, since individual performance is disguised within group average data, in line with the recommendations of Parsonson and Baer (1978), the present study displays graphic data for individual children to allow a direct evaluation of treatment effeciveness on individuals. The aim of the present study was to compare the effectiveness of the combined treatment, which is a relatively time consuming technique, with the other techniques which were being used by the psychologists of the clinic to treat stealing. METHOD Pool of subjects AN the children in the study had been routinely referred
to the only Psychological Service clinic in an area that included a city of 100,000 people and a surrounding rural
Requests for reprints should be addressed to John Q. Henderson, Psychology Service, Department of Education, Box 5147, Dunedin, New Zealand. 331
332
JOHN Q. HENDERSON
population of approximately 12,200. Each psychologist in the clinic was responsible for all the referrals which came from his or her designated geographic area. The areas were roughly similar in socioeconomic status and urban/rural distribution so there was no obvious selection bias. Because of reallocation of geographic areas and because clients tend to move around, the same child may have been seen by several different psychologists. Selection of subjects In mid-1979 a research assistant examined the files of all the youths with stealing behaviors who had been seen by the clinic between February 1974 (when Individual Combined Treatment first became available) and mid-1977. All the youths were selected for whom data over at least 3 yr were available and for whom stealing had been a major problem at some time. There were 27 such cases and from these the research assistant transferred the information about stealing to data sheets which were anonymous. When the author used the data sheets he did not know the child or who had treated the child, except for those who received the individual combined treatment which he, perforce, recognized. Measures A set of data sheets was completed for each of the 27 files, one data sheet for each time the child reappeared in the clinic. Each data sheet showed: the date of this referral or reappearance; the present frequency of stealing, value of goods stolen, and how long it had been going on; changes in stealing frequency and value since last seen, and when these changes occurred; the present placement of the child (if not at home), and school placement (if not attending local school); and treatment, or action taken on this occasion. The different assessment techniques and report writing styles of the various psychologists meant that all the required information was not always directly recorded but had to be inferred from a close reading of the file. When all the data sheets had been completed for a file, the last psychologist to have seen the child was asked to make contact and find out what had happened, as regards the stealing, since he or she last saw the child. Data presentation In this presentation the independent variable (treatment) involved eight defined techniques, and the dependent variable (stealing) four levels of stealing. Both variables were graphed against calendar time (to the nearest quarter year). To test hypotheses of their own or to check the author’s figures readers have only to use a ruler to measure lengths of bar in Fig. 1, the time scale being given on the horizontal axis. Since age is an important historical variable in delinquency, the age of the child at the start of the bar is indicated for the reader’s interest. Definitions Treatment. Forty different treatment techniques had been used on the 27 children. These were condensed into eight categories on the basis of apparent similarity of approach. The categories and their letter codes were:
1. Left; no direct action taken (L) which included extinction, ignoring, psychometric test and report with or without written recommendations, verbal recommendations to parent(s) at one interview only, waiting list, non-specific guidance such as “give increased responsibility/trust at school”. Also included in this category is: return home from boarding school or institution (indicated by an H below the child’s bar). 2. Counselling (C) included play therapy, psychiatric outpatient, attending Youth for Christ group, counselling by any professional or para professional and family therapy. 3. Individualized Combined Treatment (I.C.T.) included only those children given the full treatment described in the ‘Stealing Treatment Manual’ (Henderson, 1979*). This uses relaxation, biofeedback, suggestion, covert practice and operant techniques to alter the client’s response to stimuli which have been signal stimuli for stealing. 4. Residential (R) included enrolment in a residential school for the emotionally disturbed, admission to psychiatric hospital as an in-patient, admission to a Social Welfare residential institution, admission to a residential school for disturbed and educable mentally retarded children. 5. Special class (S) included enrolment in a special class for educable mentally retarded children, enrolment in an adjustment class for emotionally disturbed children, enrolment in a work experience class, or in any form of special education which the child attended while resident at home or in a foster home. 6. Respondent/operant(B) included covert sensitization, group or individual relaxation training, parent or psychologist devised operant programmes. 7. Punishment (P) included being bound over by a court, a police warning, a fine or other court action. 8. Boarding school (X) included anything involving a change of residence and a change of school that was not included under Residential. One case fell into both counselling and boarding school treatment categories simultaneously. It was coded as X because the boarding school program was longer than the counselling program. Stealing. Frequency, duration and value were condensed into three levels, “High, “Low” and “Nil”, by weighting them in the following way: 1. Frequency: was given a weight of “3” if the child was stealing at least once a week; a weight of “2” if less than once a week but more than once a month; a weight of “1” if once a month or less; and a weight of “0” if no stealing had been done for three months or more. (Stealing binges lasting up to a week and occurring every two or three months were counted as one stealing episode and given a frequency weighting of one.) 2. Duration: was given a weight of “3” if the child had been stealing for more than 2 yr; a weight of “2” if stealing had been going on for between 1 and 2 yr; a weight of “1” if it had been going on less than 1 yr; and a weight of “0” if there had been no stealing in the past three months. 3. Value: was given a weight of “3” if each stealing episode netted more than 10 dollars; a weight of “2” for l-10 dollars; a weight of “1” if less than 1 dollar; and a weight of “0” if there was no stealing.
*The Treatment Manual is available free of charge from The Chief Psychologist, Dept. of Education, P.B., Government Bldgs, Wellington, N.Z.
333
STEALING BEHAVIOR The three weights were summed and coded in the following way to show the level of seriousness of the stealing problem: High level: (shown as a solid bar) weights total “5” or more. Low levef: (shown as a shaded bar) weights total “3” or “4”. Not stealing: (shown as unshaded bar) weights total “0”. No Opportunity: (dotted bar) weights total “0” and the child is in a “secure” environment. Reliability of measures Preparatory to drawing the bar graphs the research assistant and the author each independently drew up a summary sheet from the data sheets using the definitions spelled out above. Each child’s summary bar was marked off in quarter years and the bars from the two summary sheets were compared in terms of agreement about the quarter year in which there was a change in stealing level or in treatment. This gave binary data (either there was agreement about any particular quarter or there was not) so reliability of coding the time at which a change occurred was calculated from: ‘Agreements divided
by agreements plus disagreements’. Reliability of the time dimension was 93% over all. More than half the bars had 100% reliability, the lowest reliability for a single bar was 75%. Reliability of coding of stealing at the four levels (High, Low, Nil, No Opportunity) was found to be 100%. Reliability of coding of treatment using the eight categories listed above was 98%. The only disagreement was in a case that had come before the court, and was coded P on one summary sheet but was coded C on the other because the court had recommended Social Welfare oversight and this fell in the counselling category. (Since it was a court action it was decided to label it P on the bar-graph.) In drawing the bar-graphs, differences between the two summary sheets regarding time of occurrence of a change were averaged out. Reliability of coding the major variables “treatment” and “stealing level” was virtually 100% but it should be noted that there is no measure of the reliability of the sources from which the data were taken, nor of the transfer of the information from those sources to the data sheets.
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Age in years at start of record Combined treatmentt 1.C.T) Respondent/operant
l-l L P R S X
Returned home (from RI Left: no action taken Punished Residential placement Specialclass or school Boarding school High level of stealing
stmllllllllmIlllllllrmlllllllllT[lllllll L ‘968
I ,969
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Fig. 1. Treatment and stealing histories of 27 children.
B 1 ,978
0 I 1979
334
JOHN Q. HENDERSON
RESULTS A comparison of Individualized Combined Treatment with other treatments Taking a point 2 yr before the end of each bar in Fig. 1 as the cut-off point (so as to ensure 2 yr-follow-up), the first major treatment occurring before this cut-off point was classified under one of two headings. Either it was Individualized Combined Treatment (bars l-lo), or it was not (bars 1l-27). For each child the length of followup consequent upon the major treatment was noted in quarter years, and the number of quarter years in which not-stealing occurred was also noted. Those children given the combined treatment spent 97.5% of their total follow-up time not stealing. Those given other treatments spent 54.4% of their total follow-up time not stealing. The two groups clearly differed after treatment. To test whether or not the children differed in seriousness or amount of time spent not stealing before treatment, the bars before the major treatment were examined and showed that the percentages of time spent not stealing were 8.6 and 9.2% respectively. (Periods of no opportunity were excluded from the calculations.) The two groups clearly did not differ before treatment in amount of time spent stealing. However, in terms of seriousness of stealing at the time of treatment, the groups did differ: only one of the ten individualized combined treatment children was stealing at a low level (lo%), whereas ten of the other 17 were stealing at a low level (60%). Because of the
co-occurrence of individualized combined treatment, high 1eveI steabng and more successful outcome, it is necessary to look more closely at stealing level and treatment outcomes over all the bar graphs. Outcome by stealing level at time of treatment Low level. On one occasion a child (bar number 7) stealing at a low level was treated using the combined treatment; 100% of his subsequent time was spent not stealing. On 19 occasions children stealing at a low level were treated using other treatments; 45% of their subsequent time was spent not stealing. High level. On nine occasions children stealing at a high level were treated using the combined treatment; 97% of subsequent time was spent not stealing. On 32 occasions children stealing at a high level were treated using other treatments; 18% of their subsequent time was spent not stealing. No opportunity. No analysis was done. Clearly the prognosis is worse if the child is stealing at a high level when admitted to treatment. Outcome by stealing level at start of bar Not-stealing. Three children (bars 1,7 and 21) were first referred to the clinic when they were not stealing (see Table 1). This was followed by 5 quarter years of low level stealing (8%), 1 quarter year of high level stealing (~VO),and 56 quarter years of no stealing. Ninety per cent of these bars is covered by not stealing.
Table 1. Outcome by stealing level at start of bar Stealing level when first seen in clinic
Not stealing Low level High level
N
3 13 11
Number given Individualized Combined Treatment at some time
2 5 3
Proportion of total caseline spent stealing at: Nil
Low level
High level
0.90 0.45 0.31
0.08 0.41 0.11
0.02 0.14 0.58
335
STEALING BEHAVIOR Table 2. Relationship between stealing level and type of treatment, with type of treatment and post treatment stealing level Before treatment number of cases stealing at:
Type of treatment
Low High N.O. level level
Proportion of time after treatment spent stealing at: Nil
Low High level level
0.9
0.1
0
0.7
0.1
0.2
0.5
0
0.5
Left
0.4 0.3
0.1 0.5
0.5 0.2
0
Special Education
0
0.2
0.8
0
Residential
o*
0
0.4
1 0 1 1 12
Individualized Combined Treatment Behavioural Punishment Counselling
N.O. = No opportunity. *0.6 had no opportunity. Low fevei. Thirteen children were fast referred to the clinic when stealing at a low level. This was followed by 121 quarter years of low level stealing (41%), 42 quarter years of high level stealing (14%), and 135 quarter years of no stealing. Forty-five per cent of these bars is covered by not stealing. High level. Eleven children were first referred when stealing at a high level. This was followed by 20 quarter years of low level stealing (11 Ore), 106 quarter years of high level stealing (58Vo), and 57 quarter years of no stealing. Thirty-one per cent of these bars is covered by not stealing. Clearly the prognosis is worse if the child is first referred to the clinic when stealing is at a higher level.
Outcome by treatment There were 66 clearly distinguishable treatment cases. The left hand side of Table 2 shows that the type of treatment given is related to the level of the presenting problem, high level cases received Special Education, Residential, Behavioral, Punishment or Individualized Combined, treatment programs. Low level cases received Left, while Counselling programs are divided equally between low and high level stealing (see Table 3). The right hand side of Table 2 shows the outcomes of the different treatments as a proportion of the total time after treatment
Table 3. Relationship between stealing level and outcome of counselllng treatment Stealing level before counselling treatment
Low High
N
I 8
Proportion of time after treatment spent stealing at: Nil
Low
High
0.5 0.1
0.3 0.0
0.2 0.9
until the next treatment or final follow-up. Individualized combined treatment can clearly be seen to be the most effective in that it has the highest proportion of not stealing and the lowest proportion of high level stealing. This is follow&d by Behavioral with Punishment and Counselling about equally successful, but as can be seen from Table 3, Counselling tends to be successful with low level presenting cases, and unsuccessful with high level cases. The figures for Left suggest that spontaneous remission is around 30%. Special Education and Residential placement quite clearly have the poorest outcomes as regards their effect on stealing. Recidivism In this study recidivism means the re-occurrence of stealing at any level on at least one occasion within 2 yr after the major treatment
336
JOHN Q. HENDERSON
(defined above). It is shown on the bar graph as no change to unshaded or as a change back from unshaded after treatment. In terms of this more common outcome measure, the rates were 20% for those given the combined treatment, 60% for those given other treatments and 75% for those who were Left.
DISCUSSION From the present study it is evident that those children treated using the combined treatment stood a better chance of achieving considerable periods of not-stealing than children given other treatments, irrespective of age, previous treatments, duration of stealing, level of stealing at time of treatment or level at first referral to the clinic. There is a relationship between level of stealing at first referral and the level of subsequent stealing. Those first seen by the clinic before they started stealing spent 17% of their subsequent stealing time stealing at a high level. Those first seen at a low level of stealing spent 26% of their subsequent stealing time stealing at a high level, and those first seen at a high level of stealing spent 84% of their subsequent stealing time stealing at a high level. Table 1 shows there is no relationship between first presenting level and later treatment with individualized combined treatment, but there is clearly a higher probability of receiving the combined treatment when stealing at a high level (only 1 of 10 children got the combined treatment when stealing at a low level). Punishment, behavioral treatment and individualized combined treatment tend to be used when the client has high level stealing, and when used are 50, 70 and 90% effective, respectively. Counselling treatment is probably less demanding of highly qualified professional time than individualized combined treatments or behavioral treatments and if used with clients presenting a low level of stealing is 50% effective and for children so treated only 20% of post treatment stealing time is at a high level. However, counselling has only a 10% success
rate for those with a high level stealing problem (Table 3). Of those who were untreated 75% reoffended, which suggests that this non-random sample of youths may be comparable to other groups of youths who steal that have been studied, since this sample has recidivism rates similar to those reported in other countries over a wide time span-from the Gluecks in the 1930’s to the New Zealand Government in the 1970’s (Department of Social Welfare, 1973). Because this was a retrospective study the dependent and independent variables (stealing level, and treatment) are inextricably confounded so caution is required in evaluating the different treatment effects. Nevertheless, the combined treatment gave results so clearly different from the other treatments that there is a strong suggestion that it is an effective treatment for an important social problem that has shown resistance to a wide range of interventions. Applied field studies impose ethical and practical considerations which hamper good experimental control. This study has attempted to achieve a “non concurrent multiple treatment across individuals” design which, according to Watson and Workman (1981), may be considered to be an extension of the traditional “multiple baseline design”. However, this study lacks, as any study of stealing must, the baseline stability which is an important assumption in a multiple baseline study (Parsonson and Baer, 1978). The present study has several weaknesses, not the least of which is lack of evidence for the reliability of the original case data on which the study is based. There was no random allocation of subjects to treatments and the treatments themselves, apart from individualized combined treatment, were far less homogeneous than the eight category titles would suggest. The data are contaminated because the author was testing his own treatment and therefore, to some extent, had a vested interest in the outcome (Kassebaum, 1974). He also carried out all the individualized combined treatments, and did most of the follow-ups of these cases. Every effort was
STEALING BEHAVIOR
made to be objective and not to bias the results, but a double blind study with random assignment to treatment category would give stronger evidence of the efficacy of this treatment technique and of its ability to be generalized across therapists and settings. The initial success claimed by Reid and Patterson (1976, page 131) with subjects of similar age to those in this study was shown by Moore, Chamberlain and Mukai (1979) to fade to an offence rate around 70% when the children were old enough to start appearing in court. It is possible that the same may be found for the individualized combined treatment children, and a follow-up through the courts should be done.
REFERENCES
Axrin N. H. and Weslowski M. D. (1974) Theft reversal: An overcorrection procedure for eliminating stealing by retarded persons, J. Appl. Behav. Anal. 7, 511-583. Departmentof Social Welfare (1973) Juvenile Crime in New Zealand. Government Printer, Wellington, N.Z. Henderson J. Q. (1979) Stealing: Combined Treatment Manual. Available from: The Chief Psychologist, Depart-
331
ment of Education, Private Bag, Government Buildings, Wellington, N.Z. Henderson J. Q. (1981) A behavioural approach to stealing, J. Behav. Tier. & Exp. Psychiat. li (3), 231-236. _ Jeffery C. R. (1%7) Crime prevention and control through environmental engineering, J. Crim. 7, 35-58. Kassebaum G. (1974)Delinquency and Social Policy. Prentice Hall, Englewood Cliffs. New Jersey. Moore D. R., Chamberlain Patricia and Mukai Leona H. (1979) Children at risk for delinquency: A follow-up comparison of aggressive children and children who steal, J. Abnorm. Child Psychol. 7 (3), 345-355. Parsonson B. S. and Baer D. M. (1978) The analysis and presentation of graphic data. In Single Subject Research Strategies for Evaluating Change (Ed. by Kratochwill T. R.), pp. 101-165. Academic Press, New York. Reid J. B. and Patterson G. R. (1976) The modification of aggression and stealing behavior of boys in the home setting. In Analysis of Delinquency and Aggression (Ed. by Ribes-Inesta Emilio and Bandura Albert), pp. 123-145. Lawrence Erlbaum Associates, Hillsdale, New Jersey. Stumphauser J. S. (1976) Elimination of stealing by self reinforcement of alternative behavior and family contracting, J. Behav. Ther. & Exp. Psychiat. 7, 265-268. WatsonP. J. and Workman E. A. (1981) The nonconcurrent multiple baseline across individuals design: An extension of the traditional multiple baseline design, J. Behav. Ther. & Exp. Psychiat. 12 (3), 257-261. West W. G. (1974) Serious thieves: Lower class adolescent males in a short-term deviant occupation, Dissertat. Abs. Znt. 35 (6a), 3910.
Acknowledgements-The author wishes to express his gratitude to Dr. E. L. Glynn of Auckland University for ideas concernhrg the graphic presentation, and to Joan McNeil1 as research assistant whose careful work made this study possible.
Vol. 14, No. 4, pp. 331-337,
oMl5-7916/83 s3.00+ .I0 0 1983 Pcrgamon Press Ltd.
1983.
FOLLOW-UP OF STEALING BEHAVIOR IN 27 YOUTHS AFTER A VARIETY OF TREATMENT PROGRAMS JOHN Q. HENDERSON Psychological Service, Department of Education, Dunedin, New Zealand Summary-Case histories are presented of 27 youngsters who had a major problem of stealing. The effectiveness of eight different treatments is examined in terms of proportion of follow-up time spent stealing. (Durationof follow-up was always more than 2 yr.) Clients given Individualized Combined Treatment spent 295% of follow-up time stealing, compared with 46% after other types of treatment.
Parents of children who steal suffer considerable anguish, and most will try every conceivable technique to stop the stealing. Despite this, the treatment of theft has received very little experimental attention from researchers (West, 1974; Stumphauser, 1976). Long-term followup evaluations are rare and those which have been done generally show that remedial and rehabilitation attempts have little or no effect (Jeffery, 1967; Azrin and Weslowski, 1974). The importance of long-term follow-up is indicated by a New Zealand study of 142 boys who had attended a Correction Centre and who had a cumulative yearly recidivism rate of 60, 75, 85, 90 and 91% over 5 yr (Department of Social Welfare, 1973). Extreme difficulty in finding successful interventions for stealing is suggested by Moore, Chamberlain and Mukai (1979) who found that even the “social 1earning”approach used so successfully by Reid and Patterson (1976) with aggressive children was relatively ineffective for stealing. Of the 25 children whose main presenting problem was stealing, 77% later had court recorded nonstatus offences (e.g. burglary, assault) compared with 13Vo of the aggressive children and 21% of the normative group. The present study involved a follow-up of 27 children and young persons, all of whom had
been referred to child psychological services, and for all of whom at least one referral had been because of stealing. Within the one clinic these children had received a variety of treatments at different times from different psychologists. Ten of the children had at some stage been given Individualized Combined Treatment, the behavioral approach to stealing reported by Henderson (1981). The effectiveness of different treatments is usually assessed by comparing the recidivism rate of differently treated groups. However, since individual performance is disguised within group average data, in line with the recommendations of Parsonson and Baer (1978), the present study displays graphic data for individual children to allow a direct evaluation of treatment effeciveness on individuals. The aim of the present study was to compare the effectiveness of the combined treatment, which is a relatively time consuming technique, with the other techniques which were being used by the psychologists of the clinic to treat stealing. METHOD Pool of subjects AN the children in the study had been routinely referred
to the only Psychological Service clinic in an area that included a city of 100,000 people and a surrounding rural
Requests for reprints should be addressed to John Q. Henderson, Psychology Service, Department of Education, Box 5147, Dunedin, New Zealand. 331
332
JOHN Q. HENDERSON
population of approximately 12,200. Each psychologist in the clinic was responsible for all the referrals which came from his or her designated geographic area. The areas were roughly similar in socioeconomic status and urban/rural distribution so there was no obvious selection bias. Because of reallocation of geographic areas and because clients tend to move around, the same child may have been seen by several different psychologists. Selection of subjects In mid-1979 a research assistant examined the files of all the youths with stealing behaviors who had been seen by the clinic between February 1974 (when Individual Combined Treatment first became available) and mid-1977. All the youths were selected for whom data over at least 3 yr were available and for whom stealing had been a major problem at some time. There were 27 such cases and from these the research assistant transferred the information about stealing to data sheets which were anonymous. When the author used the data sheets he did not know the child or who had treated the child, except for those who received the individual combined treatment which he, perforce, recognized. Measures A set of data sheets was completed for each of the 27 files, one data sheet for each time the child reappeared in the clinic. Each data sheet showed: the date of this referral or reappearance; the present frequency of stealing, value of goods stolen, and how long it had been going on; changes in stealing frequency and value since last seen, and when these changes occurred; the present placement of the child (if not at home), and school placement (if not attending local school); and treatment, or action taken on this occasion. The different assessment techniques and report writing styles of the various psychologists meant that all the required information was not always directly recorded but had to be inferred from a close reading of the file. When all the data sheets had been completed for a file, the last psychologist to have seen the child was asked to make contact and find out what had happened, as regards the stealing, since he or she last saw the child. Data presentation In this presentation the independent variable (treatment) involved eight defined techniques, and the dependent variable (stealing) four levels of stealing. Both variables were graphed against calendar time (to the nearest quarter year). To test hypotheses of their own or to check the author’s figures readers have only to use a ruler to measure lengths of bar in Fig. 1, the time scale being given on the horizontal axis. Since age is an important historical variable in delinquency, the age of the child at the start of the bar is indicated for the reader’s interest. Definitions Treatment. Forty different treatment techniques had been used on the 27 children. These were condensed into eight categories on the basis of apparent similarity of approach. The categories and their letter codes were:
1. Left; no direct action taken (L) which included extinction, ignoring, psychometric test and report with or without written recommendations, verbal recommendations to parent(s) at one interview only, waiting list, non-specific guidance such as “give increased responsibility/trust at school”. Also included in this category is: return home from boarding school or institution (indicated by an H below the child’s bar). 2. Counselling (C) included play therapy, psychiatric outpatient, attending Youth for Christ group, counselling by any professional or para professional and family therapy. 3. Individualized Combined Treatment (I.C.T.) included only those children given the full treatment described in the ‘Stealing Treatment Manual’ (Henderson, 1979*). This uses relaxation, biofeedback, suggestion, covert practice and operant techniques to alter the client’s response to stimuli which have been signal stimuli for stealing. 4. Residential (R) included enrolment in a residential school for the emotionally disturbed, admission to psychiatric hospital as an in-patient, admission to a Social Welfare residential institution, admission to a residential school for disturbed and educable mentally retarded children. 5. Special class (S) included enrolment in a special class for educable mentally retarded children, enrolment in an adjustment class for emotionally disturbed children, enrolment in a work experience class, or in any form of special education which the child attended while resident at home or in a foster home. 6. Respondent/operant(B) included covert sensitization, group or individual relaxation training, parent or psychologist devised operant programmes. 7. Punishment (P) included being bound over by a court, a police warning, a fine or other court action. 8. Boarding school (X) included anything involving a change of residence and a change of school that was not included under Residential. One case fell into both counselling and boarding school treatment categories simultaneously. It was coded as X because the boarding school program was longer than the counselling program. Stealing. Frequency, duration and value were condensed into three levels, “High, “Low” and “Nil”, by weighting them in the following way: 1. Frequency: was given a weight of “3” if the child was stealing at least once a week; a weight of “2” if less than once a week but more than once a month; a weight of “1” if once a month or less; and a weight of “0” if no stealing had been done for three months or more. (Stealing binges lasting up to a week and occurring every two or three months were counted as one stealing episode and given a frequency weighting of one.) 2. Duration: was given a weight of “3” if the child had been stealing for more than 2 yr; a weight of “2” if stealing had been going on for between 1 and 2 yr; a weight of “1” if it had been going on less than 1 yr; and a weight of “0” if there had been no stealing in the past three months. 3. Value: was given a weight of “3” if each stealing episode netted more than 10 dollars; a weight of “2” for l-10 dollars; a weight of “1” if less than 1 dollar; and a weight of “0” if there was no stealing.
*The Treatment Manual is available free of charge from The Chief Psychologist, Dept. of Education, P.B., Government Bldgs, Wellington, N.Z.
333
STEALING BEHAVIOR The three weights were summed and coded in the following way to show the level of seriousness of the stealing problem: High level: (shown as a solid bar) weights total “5” or more. Low levef: (shown as a shaded bar) weights total “3” or “4”. Not stealing: (shown as unshaded bar) weights total “0”. No Opportunity: (dotted bar) weights total “0” and the child is in a “secure” environment. Reliability of measures Preparatory to drawing the bar graphs the research assistant and the author each independently drew up a summary sheet from the data sheets using the definitions spelled out above. Each child’s summary bar was marked off in quarter years and the bars from the two summary sheets were compared in terms of agreement about the quarter year in which there was a change in stealing level or in treatment. This gave binary data (either there was agreement about any particular quarter or there was not) so reliability of coding the time at which a change occurred was calculated from: ‘Agreements divided
by agreements plus disagreements’. Reliability of the time dimension was 93% over all. More than half the bars had 100% reliability, the lowest reliability for a single bar was 75%. Reliability of coding of stealing at the four levels (High, Low, Nil, No Opportunity) was found to be 100%. Reliability of coding of treatment using the eight categories listed above was 98%. The only disagreement was in a case that had come before the court, and was coded P on one summary sheet but was coded C on the other because the court had recommended Social Welfare oversight and this fell in the counselling category. (Since it was a court action it was decided to label it P on the bar-graph.) In drawing the bar-graphs, differences between the two summary sheets regarding time of occurrence of a change were averaged out. Reliability of coding the major variables “treatment” and “stealing level” was virtually 100% but it should be noted that there is no measure of the reliability of the sources from which the data were taken, nor of the transfer of the information from those sources to the data sheets.
7
0 9
7’/2_
10
II
cc
I*-
R
HS
..: .-..: . . . . . :.. ..m
RC
Fc
7m
1
A
Key
,314 -
,6171e I9 -
27
.:...*...:.* “..‘,-m.
R
8
Age in years at start of record Combined treatmentt 1.C.T) Respondent/operant
l-l L P R S X
Returned home (from RI Left: no action taken Punished Residential placement Specialclass or school Boarding school High level of stealing
stmllllllllmIlllllllrmlllllllllT[lllllll L ‘968
I ,969
I 1970
B LL , ,971
I ,972
I 1973
I ,974
1 1915
c I ,976
I ,977
Fig. 1. Treatment and stealing histories of 27 children.
B 1 ,978
0 I 1979
334
JOHN Q. HENDERSON
RESULTS A comparison of Individualized Combined Treatment with other treatments Taking a point 2 yr before the end of each bar in Fig. 1 as the cut-off point (so as to ensure 2 yr-follow-up), the first major treatment occurring before this cut-off point was classified under one of two headings. Either it was Individualized Combined Treatment (bars l-lo), or it was not (bars 1l-27). For each child the length of followup consequent upon the major treatment was noted in quarter years, and the number of quarter years in which not-stealing occurred was also noted. Those children given the combined treatment spent 97.5% of their total follow-up time not stealing. Those given other treatments spent 54.4% of their total follow-up time not stealing. The two groups clearly differed after treatment. To test whether or not the children differed in seriousness or amount of time spent not stealing before treatment, the bars before the major treatment were examined and showed that the percentages of time spent not stealing were 8.6 and 9.2% respectively. (Periods of no opportunity were excluded from the calculations.) The two groups clearly did not differ before treatment in amount of time spent stealing. However, in terms of seriousness of stealing at the time of treatment, the groups did differ: only one of the ten individualized combined treatment children was stealing at a low level (lo%), whereas ten of the other 17 were stealing at a low level (60%). Because of the
co-occurrence of individualized combined treatment, high 1eveI steabng and more successful outcome, it is necessary to look more closely at stealing level and treatment outcomes over all the bar graphs. Outcome by stealing level at time of treatment Low level. On one occasion a child (bar number 7) stealing at a low level was treated using the combined treatment; 100% of his subsequent time was spent not stealing. On 19 occasions children stealing at a low level were treated using other treatments; 45% of their subsequent time was spent not stealing. High level. On nine occasions children stealing at a high level were treated using the combined treatment; 97% of subsequent time was spent not stealing. On 32 occasions children stealing at a high level were treated using other treatments; 18% of their subsequent time was spent not stealing. No opportunity. No analysis was done. Clearly the prognosis is worse if the child is stealing at a high level when admitted to treatment. Outcome by stealing level at start of bar Not-stealing. Three children (bars 1,7 and 21) were first referred to the clinic when they were not stealing (see Table 1). This was followed by 5 quarter years of low level stealing (8%), 1 quarter year of high level stealing (~VO),and 56 quarter years of no stealing. Ninety per cent of these bars is covered by not stealing.
Table 1. Outcome by stealing level at start of bar Stealing level when first seen in clinic
Not stealing Low level High level
N
3 13 11
Number given Individualized Combined Treatment at some time
2 5 3
Proportion of total caseline spent stealing at: Nil
Low level
High level
0.90 0.45 0.31
0.08 0.41 0.11
0.02 0.14 0.58
335
STEALING BEHAVIOR Table 2. Relationship between stealing level and type of treatment, with type of treatment and post treatment stealing level Before treatment number of cases stealing at:
Type of treatment
Low High N.O. level level
Proportion of time after treatment spent stealing at: Nil
Low High level level
0.9
0.1
0
0.7
0.1
0.2
0.5
0
0.5
Left
0.4 0.3
0.1 0.5
0.5 0.2
0
Special Education
0
0.2
0.8
0
Residential
o*
0
0.4
1 0 1 1 12
Individualized Combined Treatment Behavioural Punishment Counselling
N.O. = No opportunity. *0.6 had no opportunity. Low fevei. Thirteen children were fast referred to the clinic when stealing at a low level. This was followed by 121 quarter years of low level stealing (41%), 42 quarter years of high level stealing (14%), and 135 quarter years of no stealing. Forty-five per cent of these bars is covered by not stealing. High level. Eleven children were first referred when stealing at a high level. This was followed by 20 quarter years of low level stealing (11 Ore), 106 quarter years of high level stealing (58Vo), and 57 quarter years of no stealing. Thirty-one per cent of these bars is covered by not stealing. Clearly the prognosis is worse if the child is first referred to the clinic when stealing is at a higher level.
Outcome by treatment There were 66 clearly distinguishable treatment cases. The left hand side of Table 2 shows that the type of treatment given is related to the level of the presenting problem, high level cases received Special Education, Residential, Behavioral, Punishment or Individualized Combined, treatment programs. Low level cases received Left, while Counselling programs are divided equally between low and high level stealing (see Table 3). The right hand side of Table 2 shows the outcomes of the different treatments as a proportion of the total time after treatment
Table 3. Relationship between stealing level and outcome of counselllng treatment Stealing level before counselling treatment
Low High
N
I 8
Proportion of time after treatment spent stealing at: Nil
Low
High
0.5 0.1
0.3 0.0
0.2 0.9
until the next treatment or final follow-up. Individualized combined treatment can clearly be seen to be the most effective in that it has the highest proportion of not stealing and the lowest proportion of high level stealing. This is follow&d by Behavioral with Punishment and Counselling about equally successful, but as can be seen from Table 3, Counselling tends to be successful with low level presenting cases, and unsuccessful with high level cases. The figures for Left suggest that spontaneous remission is around 30%. Special Education and Residential placement quite clearly have the poorest outcomes as regards their effect on stealing. Recidivism In this study recidivism means the re-occurrence of stealing at any level on at least one occasion within 2 yr after the major treatment
336
JOHN Q. HENDERSON
(defined above). It is shown on the bar graph as no change to unshaded or as a change back from unshaded after treatment. In terms of this more common outcome measure, the rates were 20% for those given the combined treatment, 60% for those given other treatments and 75% for those who were Left.
DISCUSSION From the present study it is evident that those children treated using the combined treatment stood a better chance of achieving considerable periods of not-stealing than children given other treatments, irrespective of age, previous treatments, duration of stealing, level of stealing at time of treatment or level at first referral to the clinic. There is a relationship between level of stealing at first referral and the level of subsequent stealing. Those first seen by the clinic before they started stealing spent 17% of their subsequent stealing time stealing at a high level. Those first seen at a low level of stealing spent 26% of their subsequent stealing time stealing at a high level, and those first seen at a high level of stealing spent 84% of their subsequent stealing time stealing at a high level. Table 1 shows there is no relationship between first presenting level and later treatment with individualized combined treatment, but there is clearly a higher probability of receiving the combined treatment when stealing at a high level (only 1 of 10 children got the combined treatment when stealing at a low level). Punishment, behavioral treatment and individualized combined treatment tend to be used when the client has high level stealing, and when used are 50, 70 and 90% effective, respectively. Counselling treatment is probably less demanding of highly qualified professional time than individualized combined treatments or behavioral treatments and if used with clients presenting a low level of stealing is 50% effective and for children so treated only 20% of post treatment stealing time is at a high level. However, counselling has only a 10% success
rate for those with a high level stealing problem (Table 3). Of those who were untreated 75% reoffended, which suggests that this non-random sample of youths may be comparable to other groups of youths who steal that have been studied, since this sample has recidivism rates similar to those reported in other countries over a wide time span-from the Gluecks in the 1930’s to the New Zealand Government in the 1970’s (Department of Social Welfare, 1973). Because this was a retrospective study the dependent and independent variables (stealing level, and treatment) are inextricably confounded so caution is required in evaluating the different treatment effects. Nevertheless, the combined treatment gave results so clearly different from the other treatments that there is a strong suggestion that it is an effective treatment for an important social problem that has shown resistance to a wide range of interventions. Applied field studies impose ethical and practical considerations which hamper good experimental control. This study has attempted to achieve a “non concurrent multiple treatment across individuals” design which, according to Watson and Workman (1981), may be considered to be an extension of the traditional “multiple baseline design”. However, this study lacks, as any study of stealing must, the baseline stability which is an important assumption in a multiple baseline study (Parsonson and Baer, 1978). The present study has several weaknesses, not the least of which is lack of evidence for the reliability of the original case data on which the study is based. There was no random allocation of subjects to treatments and the treatments themselves, apart from individualized combined treatment, were far less homogeneous than the eight category titles would suggest. The data are contaminated because the author was testing his own treatment and therefore, to some extent, had a vested interest in the outcome (Kassebaum, 1974). He also carried out all the individualized combined treatments, and did most of the follow-ups of these cases. Every effort was
STEALING BEHAVIOR
made to be objective and not to bias the results, but a double blind study with random assignment to treatment category would give stronger evidence of the efficacy of this treatment technique and of its ability to be generalized across therapists and settings. The initial success claimed by Reid and Patterson (1976, page 131) with subjects of similar age to those in this study was shown by Moore, Chamberlain and Mukai (1979) to fade to an offence rate around 70% when the children were old enough to start appearing in court. It is possible that the same may be found for the individualized combined treatment children, and a follow-up through the courts should be done.
REFERENCES
Axrin N. H. and Weslowski M. D. (1974) Theft reversal: An overcorrection procedure for eliminating stealing by retarded persons, J. Appl. Behav. Anal. 7, 511-583. Departmentof Social Welfare (1973) Juvenile Crime in New Zealand. Government Printer, Wellington, N.Z. Henderson J. Q. (1979) Stealing: Combined Treatment Manual. Available from: The Chief Psychologist, Depart-
331
ment of Education, Private Bag, Government Buildings, Wellington, N.Z. Henderson J. Q. (1981) A behavioural approach to stealing, J. Behav. Tier. & Exp. Psychiat. li (3), 231-236. _ Jeffery C. R. (1%7) Crime prevention and control through environmental engineering, J. Crim. 7, 35-58. Kassebaum G. (1974)Delinquency and Social Policy. Prentice Hall, Englewood Cliffs. New Jersey. Moore D. R., Chamberlain Patricia and Mukai Leona H. (1979) Children at risk for delinquency: A follow-up comparison of aggressive children and children who steal, J. Abnorm. Child Psychol. 7 (3), 345-355. Parsonson B. S. and Baer D. M. (1978) The analysis and presentation of graphic data. In Single Subject Research Strategies for Evaluating Change (Ed. by Kratochwill T. R.), pp. 101-165. Academic Press, New York. Reid J. B. and Patterson G. R. (1976) The modification of aggression and stealing behavior of boys in the home setting. In Analysis of Delinquency and Aggression (Ed. by Ribes-Inesta Emilio and Bandura Albert), pp. 123-145. Lawrence Erlbaum Associates, Hillsdale, New Jersey. Stumphauser J. S. (1976) Elimination of stealing by self reinforcement of alternative behavior and family contracting, J. Behav. Ther. & Exp. Psychiat. 7, 265-268. WatsonP. J. and Workman E. A. (1981) The nonconcurrent multiple baseline across individuals design: An extension of the traditional multiple baseline design, J. Behav. Ther. & Exp. Psychiat. 12 (3), 257-261. West W. G. (1974) Serious thieves: Lower class adolescent males in a short-term deviant occupation, Dissertat. Abs. Znt. 35 (6a), 3910.
Acknowledgements-The author wishes to express his gratitude to Dr. E. L. Glynn of Auckland University for ideas concernhrg the graphic presentation, and to Joan McNeil1 as research assistant whose careful work made this study possible.