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Recent trends toward a more punitive approach to juvenile crime have been heavily influenced by a body of review literature that reports that the traditional treatment approach is ineffective. The opinion that “nothing works” is largely based on reviews of the treatment literature. These reviews generally fail to document the amount of change associated with treatment. A meta-analysis of the primary research literature produced since 1960 was undertaken to assess the amount of change associated with various treatments of adjudicated delinquents. There were 111 studies identified that used a comparison group or pre-post design. Results indicated that treatment of adjudicated delinquents resulted in a positive change of .37 standard deviations. No consistent evidence on the relative efficacy of behavioral versus psychodynamic approaches was found. Recidivism was modestly reduced; institutional adjustment, psychological adjustment, and academic performance were all improved following treatment. The results of the meta-analysis suggest that treatment of adjudicated delinquents in an institutional or community residential setting does “work.”

ABSTRACT. Objective. Child fatality review teams have emerged across the United States in the past decade to address the concern that systems of child protection, law enforcement, criminal justice, and medicine do not adequately assess the circumstances surrounding child fatality as a result of maltreatment.Methods. We compared data collected by a multidisciplinary child fatality review team with vital records for all children who were aged birth to 16 years and died in Colorado between January 1, 1990, and December 1, 1998. Odds ratios and 95% confidence intervals for ascertainment by the death certificate were estimated using logistic regression.Results. Only half of the children who died as a result of maltreatment had death certificates that were coded consistently with maltreatment. Black race and female gender were associated with higher ascertainment, whereas death in a rural county was associated with lower ascertainment. Deaths resulting from violent causes (eg, shaking, blunt force trauma, striking) were more likely to be ascertained than those that involved acts of omission (eg, neglect and abandonment, drowning, fire). The most common perpetrators of maltreatment were parents. However, maltreatment by an unrelated perpetrator was 8.71 times (95% confidence interval: 3.52-21.55) more likely to be ascertained than maltreatment by a parent.Conclusions. The degree of underascertainment found in this study is of concern because most national estimates of child maltreatment fatality in the United States are derived from coding on death certificates. In addition, the patterns recognized in this study raise concern about systematic underascertainment that may affect children of specific sociodemographic groups. Pediatrics 2002;110(2). URL: http://www.pediatrics.org/ cgi/content/full/110/2/e18; child abuse, death certificates, vital statistics, mortality, infant mortality, data collection, public health, records, logistic models, statistical models, cause of death, child welfare, battered child syndrome, child advocacy, infanticide.ABBREVIATIONS. CFRC, child fatality review committee; ICD, International Classification of Diseases; SES, socioeconomic status. T here has long been concern regarding the adequacy of death certificates in determining the magnitude of fatalities from child abuse and neglect. Previous studies have estimated that between 52% and 85% of maltreatment fatalities are misidentified as attributable to accidents, natural causes, or other unknown causes. [1][2][3][4] In 1993, the Centers for Disease Control and Prevention concluded that death certificates were an uncertain source of data on child maltreatment fatalities and recommended modifying the system to make identification easier. 3 However, these changes have not occurred. The inability of any one system of child protection, law enforcement, health, or criminal justice to recognize, track, and assess the circumstances of child maltreatment deaths has led to the development of interagency multidisciplinary child fatality review teams ac...

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