A Systematic Review of the Effectiveness of Family Interventions in Reducing Juvenile Recidivism

  • Kavitha K. Anandalingam
  • Carly L. Baetz
  • Emily C. Weinberger
  • Michael Zingman
  • Alison S. McCann
  • and Sarah McCue Horwitz
  • Journal of the American Academy of Psychiatry and the Law Online
  • September 2026,
  • 54
  • (3)
  • 318-329;
  • DOI: https://doi.org/10.29158/JAAPL.260083-26

Abstract

Family-based interventions have been shown to improve behavioral and justice-related outcomes for youth. There has been less focus on whether family-based interventions are effective at reducing youth recidivism, especially for newer or lesser known interventions. To address this gap, we conducted a systematic review of studies utilizing family-based interventions to address recidivism for youth involved in the juvenile justice system. Of the identified 3,497 unique articles, 235 full-text articles were reviewed and 31 met criteria for inclusion in the review. A variety of family-based interventions were used, including both widely known (e.g., multisystemic therapy) and lesser known interventions. Most studies demonstrated significant reductions in recidivism, with some mixed findings depending on the type of charge, assessment timepoint, measure of recidivism, or moderating factors. The findings from this review corroborate prior research on the effectiveness of well known interventions for reducing recidivism and highlight the promise of newer interventions. The results also highlight the need for additional research in this area, as well as a greater focus on better understanding the moderating factors that may affect treatment outcomes.

Ongoing involvement in the juvenile justice system can have a detrimental impact on youths’ developmental trajectories, as well as on their families and communities. Family-based interventions, such as multisystemic therapy (MST), multidimensional treatment foster care (MTFC), and functional family therapy (FFT), have been identified as effective methods to break the cycle of delinquency by addressing behaviors that lead to justice system contact.1,2 These interventions are based on social-ecological models that intervene at multiple levels, including family, school, peers, and community.

Although prior reviews have summarized the evidence on the impact of family-based interventions on youth behavioral and other justice-related outcomes, many have failed to use a systematic approach.3,–,5 Among systematic reviews, most have focused on a single treatment modality or designated subset of interventions.6,–,9 Although youth involvement in the justice system remains a significant concern in the United States,10,11 few systematic reviews or meta-analyses have examined the effects of family-based interventions exclusively for youth in the juvenile justice system12 or used juvenile recidivism as a primary outcome.13,14 In one of the few meta-analyses to examine juvenile recidivism,15 family and parenting interventions (MST, MTFC, and parent training) reduced the risk of rearrest, time spent in institutions, and self-reported delinquent behavior. Notably, this study and a corresponding Cochrane review16 were conducted over 20 years ago and included a small number of studies (n = 8).

In the most recent meta-analysis on this topic, Dopp and colleagues12 demonstrated that family-based treatments had a small but positive effect across a variety of outcomes, including youth antisocial behavior. These effects were found to be long lasting, with an average follow-up of 2.5 years. All but two of the included studies investigated the most well studied interventions (MST, FFT, MTFC). In that study, the effect size encompassed many different outcomes, recidivism was not operationalized as a separate variable, and the review was limited to youth with more serious offenses.

The Current Study

The primary aim of this study was to systematically review the past 20 years of empirical evidence on the effectiveness of family-based interventions for reducing recidivism in youth involved in the U.S. juvenile justice system. This timeline was selected to capture research that has been conducted since the most recent relevant Cochrane review16 was published. To our knowledge, no systematic reviews have specifically assessed the impact of family-based interventions on youth recidivism as a distinct outcome since the early 2000s. This represents a notable gap in the literature, especially given the high rates of youth returning to the juvenile justice system. Recidivism has a detrimental impact on public safety, further highlighting the importance of gaining updated knowledge on effective interventions for reducing youth involvement in the juvenile justice system.

Given the number of new studies and less widely known interventions that have emerged over the past two decades, this article also evaluates recent and lesser known interventions often not included in previous reviews. Although the most recent meta-analysis focused exclusively on youth with more serious offenses,12 the current study includes a broader range of youth with juvenile justice system involvement. Our narrative synthesis also identifies potential gaps in the evidence base and suggests areas for future research.

Methods

The study protocol was developed by the first author in accordance with the 2009 Checklist for Preferred Reporting Items for Systematic Reviews and Meta-Analyses.17 The review was registered with PROSPERO (CRD42022304599) on February 18, 2022 and can be accessed at https://www.crd.york.ac.uk/PROSPERO/view/CRD42022304599. We generated the following review question using the population, intervention, comparison, and outcome (PICO) framework: among youth involved in the juvenile justice system, are family or caregiver interventions effective at reducing recidivism?

Search Methods and Strategy

The literature search strategy was developed by an author (K.K.A.) and a medical school librarian with systematic review experience. The final search terms included (family OR families OR caregiver OR caregivers OR guardians OR guardian OR parent OR parents) AND (treatment OR intervention OR therapy OR psychotherapy OR training OR psychoeducation OR psychoeducational OR family therapy OR multi systemic therapy OR multisystemic therapy) AND (juvenile delinquency [tiab] OR juvenile delinquency [MeSH] OR juvenile delinquent [tiab] OR juvenile justice OR adjudicated [tiab] OR offender [tiab] OR offenders [tiab] OR “court involved”).

The final search strategy was run by the medical librarian across 13 databases: PubMed, Medline (Ovid), Embase (Ovid), APA PsycInfo (Ovid), the Cochrane Library, the Campbell Collaboration, CINAHL, Biosis Citation Index (BCI), Criminal Justice Abstracts, ERIC/Education Source (EBSCOHost), Global Health, Russian Science Citation Index, and Web of Science. The language was restricted to English, and dates were limited to studies published after 1998.

The initial search was run in November 2021. Data were exported from EndNote to Covidence, a web-based systematic review management program. Titles and abstracts of articles obtained in the search were independently screened by two authors (K.K.A. and A.S.M.), and another author (C.L.B.) resolved all conflicts. All screened records that met the first round of inclusion criteria were transferred to Google Sheets, and two authors (K.K.A. and A.S.M.) assessed the full texts using a data form designed with inclusion and exclusion variables. Two authors (K.K.A. and C.L.B.) discussed and resolved disagreements about inclusion during the full text review. If information necessary to make a decision about assessment was unclear, an author (K.K.A.) contacted authors to obtain this information. One study18 was excluded because of insufficient outcome data from both the publication and the author. Following the full text review, an author (K.K.A.) conducted a reference list review of included publications. Additional publications identified were reviewed in the same manner as those identified in the electronic searches. The database search process was repeated in December 2023 by two authors (K.K.A. and M.Z.) to identify studies that had been published since the initial search was conducted.

Inclusion Criteria

Studies were eligible for inclusion if they evaluated the effectiveness of a family or caregiver intervention; included only youth under age 18 who had current, formal engagement with the juvenile justice system; included at least two separate groups with randomized or nonrandom assignment and pre- and posttreatment outcome comparisons; included results from quantitative data analyses with at least one outcome related to recidivism; were published in English in a peer-reviewed journal; and were conducted in the United States.

Evaluation of Bias

Risk of bias in studies was assessed using either Version 2 of the Cochrane Risk-of-Bias tool for randomized trials (RoB 2) or The Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I), based on the Cochrane protocol.19,20 Evaluation was performed by an author (K.K.A.), with discussion with two authors (E.C.W. and C.L.B.) to resolve questions. Studies were rated low, some, or high risk of bias within each category of risk.

Data Extraction

Three authors independently extracted data from the included studies (K.K.A., E.C.W., and A.S.M.) using a standardized data form. Extracted variables included, but were not limited to, the characteristics of the study design, sample size (total, treatment, and comparison and control groups), participant demographics, type of family or caregiver intervention utilized, treatment setting, type of comparison or control condition, outcomes by type, time point, measurement, and source. A complete list of extracted variables is available upon request.

Data Analysis

Recidivism was the primary outcome examined across studies. Studies were grouped by type of intervention, and data on the characteristics and outcomes of included studies were synthesized.

Results

Results of Literature Search

During the initial literature search performed in November 2021, 3,109 unique records were identified. Of those records, 2,878 articles were excluded during the initial screening. After a full text review of 231 articles, 27 studies were included. Interrater agreement was .85. Three additional articles were identified for inclusion based on bibliography review.

In December 2023, a second literature search was completed to identify records that were published since the initial search. During the second search, 388 additional unique records were identified. Of those records, 383 articles were excluded during the initial screening. After a full text review of five articles, one remaining study was added to the review.

After both the initial and second searches were completed, a total of 31 studies were included in the final review (see online supplement). Top reasons for exclusion included that the study did not use the appropriate design (31.3%) or was not exclusively focused on youth with current, formal juvenile justice contact (19.8%). See Figure 1 for more details about the literature search process.

Flowchart of article search and selection.
Figure 1.

Flowchart of article search and selection.

Risk of Bias

Risk of bias analysis is reported in Table 1 and Table 2. For randomized control trials, 26.3 percent had high risk of bias in at least one category and 73.7 percent had some risk of bias, mainly influenced by missing information on allocation concealment or the lack of a prespecified analysis plan. For nonrandomized trials, 66 percent had serious risk of bias in at least one category, 16.7 percent had moderate risk of bias in at least one category, and 16.7 percent were low risk in all categories. The nonrandomized studies did not provide prespecified analysis plans, though these were judged to be low risk given differences in the two risk of bias tools.

View this table:
Table 1

Risk of Bias Tool for Randomized Trials (RoB-2)

View this table:
Table 2

Risk of Bias for Nonrandomized Studies (ROBINS-1)

Study Characteristics

All included studies were peer-reviewed journal articles published in 2000 or later, with the exception of one article published in 1999. All studies took place in the United States, with 12.9 percent in the Northeast, 22.6 percent in the South, 29.0 percent in the Midwest, and 32.3 percent in the West. One study did not specify its location. Of the studies, 61 percent were randomized controlled trials (RCT), whereas 39 percent were quasi-experimental.

The studies utilized treatment interventions that included MST (22.6%), FFT (12.9%), MTFC (16.1%), and family group conferencing (FGC; 9.6%). Twelve studies (38.7%) used less widely known interventions (see the online supplement for complete list). The interventions were delivered by a range of providers, including therapists, mental health clinicians, foster parents, mediators, and probation officers, with 51.6 percent of studies reporting information about the type of training providers received. All studies used a control or comparison group; 54.8 percent described alternate services or referrals provided to this group, whereas 45.2 percent referenced the usual justice system process or no intervention. Although 25.8 percent of studies provided quantitative fidelity data, 32.2 percent assessed fidelity without reporting outcomes. Additional information about study characteristics can be found in the online supplement.

Sample Characteristics

There were 10,141 participants across all studies, with sample sizes ranging from 48 to 1,597 (M = 327.1, SD = 383.1). The majority of participants across the studies were male (72.8%). Six studies included all male participants, whereas four studies included all female participants. Ages of participants ranged from 7 to 17, with a mean age of 14.8.

Roughly half of all participants were White (48.7%), whereas the remainder belonged to minoritized groups, including Black (21.3%), Hispanic (11.7%), Asian (.6%), and other (13%). Information on other demographic factors was provided by more than half of the studies (55%), and 42 percent of studies provided additional details about mental health or substance use histories of participants.

Participants across studies were in various stages of juvenile justice system involvement, including probation (42%), diversion (16.2%), and postdetention (9.7%). In 16.6 percent of studies, participants were included who had been mandated to treatment. For 25.8 percent of studies, the stage of justice involvement was unclear or not provided.

Sixty-five percent of studies provided information about offenses that participants were arrested for, charged with, or convicted of. There was a range of seriousness of offense, with 61 percent of studies including youth who were charged with or had a history of committing felonies, violent crimes, or serious sexual offenses.

Regarding prior arrests and criminal history, 12.9 percent of studies examined only first-time offenders, whereas 87.1 percent of studies included youth with at least one prior arrest. Detailed information regarding prior arrests and other sample characteristics can be found in the online supplement.

Recidivism Outcomes

All but one study (96.8%) used an official measure of recidivism, and 41.9 percent of studies used a self-reported measure of recidivism. Official measures of recidivism differed across studies, with rearrest as the most frequently used measure (38.7% of studies), followed by reconviction (16.1%) and reoffense (16.1%). Posttreatment outcomes related to recidivism were assessed a mean of 3.9 years to follow-up (range .5 to 24.95 years). See online supplement for further details.

Multisystemic Therapy (MST)

In the seven included studies that examined MST,33,–,39 there was improvement in long-term recidivism outcomes, with more mixed findings for short-term outcomes. For example, one set of studies conducted by Henggeler and colleagues,33,34 which used the same sample at two different times to follow-up, found no difference in recidivism outcomes at six months posttreatment, but at four years posttreatment, there was a reduction in rates of both self-reported delinquency and official reconviction for aggressive crimes.

In one long-term follow-up35 of a study from 1995,40 youth who received MST demonstrated significantly fewer rearrests (overall, violent, nonviolent, and drug offenses), a longer time to rearrest, and fewer days sentenced to adult incarceration at 13.7 years posttreatment. In a second follow-up study,36 the treatment group continued to demonstrate reductions in rearrests (violent and nonviolent felonies) and were less likely to be sentenced to adult incarceration at 21.9 years posttreatment.

In the first randomized controlled trial (RCT) of MST without direct oversight from the developers of the treatment model,37 MST participants demonstrated a significantly lower rate of rearrest than the control group and were arrested for significantly fewer new offenses at 18 months posttreatment. There were no between-group differences in the percentage of rearrests for felonies versus misdemeanors or time to rearrest.

Finally, in a set of studies examining a specific population of youth with problematic sexual behavior, Boduin and colleagues38,39 found that MST youth had lower rates of self-reported delinquency than youth in the control group at one week posttreatment, as well as fewer days in detention, a longer time to rearrest, and fewer arrests for all offenses at 8.9 years posttreatment. Youth who received MST also had a significantly longer time to rearrest when compared with control youth. At 25 years, youth in the MST group continued to demonstrate fewer arrests for sexual and nonsexual felony offenses as well as fewer days of incarceration.

Multidimensional Treatment Foster Care (MTFC)

Five studies used MTFC as the treatment intervention.41,–,45 In two studies41,42 that served as follow-ups to a study published in 1998,46 assignment to MTFC was associated with lower subsequent antisocial behavior, measured by official records and self-report, and this effect was mediated by family management skills and deviant peer association. Youth who received MTFC demonstrated significantly fewer criminal referrals for violent offenses and lower self-reports of violent offending compared with control youth two years following study entry.

In a study by Leve and colleagues,43 the MTFC group demonstrated a significant decrease in caregiver-reported delinquency and days in locked settings, but not self-reported delinquency or official criminal referrals, at 12 months postbaseline. In a corresponding follow-up study,44 the delinquency variable (a latent variable that consisted of the number of criminal referrals, number of days in locked settings, and self-reported delinquency) was significantly lower in the MTFC group compared with the control group at 12 and 24 months. When evaluating these outcomes individually, there was a significant reduction in days in locked settings for the MTFC group compared with the control group but no significant difference in number of criminal referrals or self-reported delinquency at 24 months. In an additional follow-up study,45 the MTFC group demonstrated a reduction in criminal referrals and days of incarceration at 24 months when compared with the control group, which was mediated by a reduction to exposure to delinquent peers. There was no significant difference in self-reported delinquency in the direct effects model, although the indirect effects of MTFC on self-reported delinquency and the latent variable were significant.

Notably, two of the MTFC studies measured similar outcomes (official criminal referrals and self-reported delinquency) using exclusively male42 or exclusively female43 samples. In those studies, MTFC did not have a significant impact on criminal referrals or self-reported delinquency for females, whereas there was a significant reduction in both outcomes for males.

Functional Family Therapy (FFT)

Four studies evaluated the effects of FFT or FFT for gang-involved youth (FFT-G) on recidivism.23,47–,49 In a study by Celinska and colleagues,23 there was a significant reduction in reconviction for drug, property, and technical offenses for the FFT group compared with the comparison group at 12 months. There were no significant between-group differences for overall reconvictions, violent offenses, or reinstitutionalization.

In another study,47 there was no significant difference in the overall rate of adjudicated felony offenses between the FFT and control groups at 12 months postintervention. Therapist adherence to the treatment model significantly affected outcomes. There was a statistically significant reduction in adjudicated felony offense rates in the group with high therapist adherence compared with the control group. Within the FFT group, the low therapist adherence group had a higher rate of adjudicated felony offenses versus the high therapist adherence group.

Two studies48,49 examined 129 families of adjudicated youth from a single courtroom in the Philadelphia family court with random assignment to FFT-G versus treatment as usual. They assessed recidivism outcomes at six months, 7 to 18 months, and at 18 months. Gottfredson and colleagues48 found that the FFT group had significant reductions in drug charges and the percentage of youth adjudicated delinquent during the entire follow-up period as well as a significant reduction in drug charges between 7 and 18 months of follow-up. There were no statistically significant findings at other time points or for any other recidivism outcome.

Thornberry and colleagues49 expanded on the Gottfredson48 findings with subanalyses stratifying by gang risk status. On self-report measures, only youth in the high gang risk category showed a significant decrease in general delinquency with FFT-G compared with treatment as usual. On official records of recidivism, FFT-G in high gang risk youth resulted in a significant reduction in person and property charges at six months; number of arrests, risk of arrest, and felony charges at 7 to 18 months; as well as number of arrests and charges at 18 months. FFT-G in low gang risk youth did not result in significant results for any recidivism measures at any time point. For high and low gang risk youth, FFT-G had no statistically significant impact on violent delinquency, arrests, or residential placements.

Family Group Conferencing (FGC)

Three studies examined family group conferencing (FGC) as the treatment intervention.22,50,51 Baffour22 demonstrated that FGC participants were less likely to be arrested within 18 months of treatment compared with the comparison group. McGarrell and Hipple50 found that, at 24 months follow-up, there was a lower incidence of rearrest, although this analysis does not appear to include any covariates. There was no significant difference in risk of arrest between the FCG and control groups, although the control group demonstrated a higher rate of rearrest. A long-term follow-up51 to this study found that there was no significant difference in reoffenses or time to reoffense between the FCG and control group 12 years after the initial court referral.

Other Interventions

Twelve studies used other, lesser known interventions, including Family Preservation, Step Up, Contingency Management in Combination with Family Engagement Strategies (CM-FAM), Project ASPECT, Project Back on Track, Connections, Family Solutions Program, Parenting with Love and Limits, Adolescent Diversion Project, Family Integrated Transitions, Families First, and a manualized “family based intervention.”21,24,–,32,52,53 Interventions ranged in approach from family coaching and therapy,30 to parent and youth groups,25 to wraparound services that emphasize family involvement.28

Of these studies, ten evidenced significant reductions in at least one recidivism outcome. Three studies demonstrated significant findings in all measures assessed.27,–,29 All found that the experimental group had a lower risk of reoffense, and one28 also demonstrated that the treatment group had a longer time to reoffense and spent fewer days in detention when compared with control youth. Seven studies had mixed findings, for example, significant results at some time points, but not others, or for some measures of recidivism, but not others,25,26,30,–,32,52,53 and two studies had no significant findings.21,24

Overall, studies for these interventions were methodologically weaker, with only two (16.7%) of the studies being RCTs52,53 and the rest having a quasi-experimental design. Fewer of these studies (16.7%) provided a quantitative fidelity assessment than in the overall group. Each of these interventions only had one study assessing their impact on recidivism.

Moderators

Eight studies discussed the impact of moderators on their results.33,–,36,39,47,49,52 For six (75%) of these studies, no significant moderators emerged from the analysis. One study47 found that therapist adherence and youth risk moderated the outcome, with high therapist adherence to FFT associated with lower rates of recidivism when compared with low therapist adherence. This finding was consistent for youth with high negative peer risk, but there was no difference in recidivism between high and low therapist adherence for youth with low negative peer risk. A second study49 found that gang risk moderated the outcomes, as FFT was associated with lower recidivism for high gang risk, but not low gang risk youth.

Mediators

Three studies assessed the impact of mediators on the relationship between treatment intervention and recidivism outcomes.39,41,45 Specifically, delinquent peer affiliation41,45 and family management skills41 mediated the effects of MTFC on recidivism. Improvements in peer and family relations during treatment were significant mediators of long-term outcomes for MST for problematic sexual behaviors.39

Discussion

Family-based interventions are frequently cited as the “gold standard” for reducing recidivism risk among youth in the juvenile justice system.54 The existing literature relies heavily on widely known interventions, such as MST and FFT, which are not always accessible to families or feasible for use in settings such as juvenile detention. To address this limitation, the current study sought to provide an updated synthesis on the current state of the literature, with the goal of highlighting emerging, lesser known interventions with a growing evidence base.

Randomized controlled trials were used in just over 60 percent of the studies in this review, which is a notable strength, given the challenges associated with conducting methodologically rigorous studies in juvenile justice settings. Thirty-five percent of the studies evidenced significant reductions across all measures of recidivism as a result of a family-based intervention, with about half (51%) of studies presenting a more nuanced picture of effectiveness depending upon the type of charge, assessment timepoint, measure of recidivism, or moderating factor. Thirteen percent of the studies resulted in no significant findings. This was somewhat surprising, given the widely held belief that parental involvement is a key component for the effective treatment of problematic behaviors in childhood and adolescence. The degree of family involvement varied widely across studies, making it difficult to compare across interventions. Nevertheless, the lack of consensus in treatment effectiveness suggests that more research is needed to explore the impact of family-based interventions on measures of recidivism with youth involved in the juvenile justice system, including mediators and moderators of treatment effects.

Across studies, 73 percent of the participants were male, with only four studies focused specifically on females. This is a striking imbalance, especially because girls’ representation in the juvenile justice system has increased in recent years.55 Compared with boys, girls are also disproportionately represented in status offense cases involving running away from home,56 with family conflict and interfamilial trauma underlying system involvement for many girls.57 Notably, three of the four included studies that focused exclusively on female participants used MTFC as the intervention. It is therefore imperative to better understand the impact of family-based treatments for girls in particular, especially for interventions beyond MTFC. Although differences in study design impeded our ability to make meaningful comparisons between males and females across studies, the results from two of the MTFC studies using similar outcomes suggest that the intervention may have differential effects by gender. This further highlights the importance of considering gender-responsive interventions, both in implementation and in research.

Demographically, roughly half of participants were White, with only 21 percent Black participants and 12 percent Hispanic participants. This points to the need for more studies focused on minoritized youth, who make up a disproportionate share of the juvenile justice population. One recent meta-analysis found that there were greater positive impacts of family interventions in studies that included a higher percentage of Hispanic youth.12 More work is also needed to better understand the effectiveness of cultural adaptations to family-based interventions for different groups of youth. The studies in this review were spread across the United States, and a greater focus on the impact of geographic location as well as rural versus urban jurisdictions would enhance the existing literature.

Almost all of the studies in this review focused on youth and families receiving an intervention in a community-based setting, with only one study32 beginning in a carceral setting and continuing postrelease. Youth residing in detention or incarceration settings are a particularly vulnerable population with increased risk for negative long-term outcomes, including mental health problems and continued criminal justice involvement.58 Given their heightened risk, youth in such settings are arguably most in need of evidence-based interventions that focus on the very treatment targets used in family-based interventions, yet we still know very little about the effectiveness of such interventions in carceral settings. One possible reason for this limited knowledge is that there are many barriers to family engagement in detention and incarceration settings, including barriers faced by families, such as lack of childcare or transportation, and barriers at the system level, such as stigma, blame, and lack of physical space.59

The overwhelming majority of studies in this review (87%) also included youth with at least one prior arrest, with only 13 percent of studies focused exclusively on first-time offenders. This represents a significant gap in the literature and a missed opportunity to target youth who could be effectively diverted from further system involvement with secondary intervention. More research is clearly needed to identify family-based interventions focused on reducing the risk of future system involvement after an initial arrest.

Well Known Interventions

MST, MTFC, and FFT

Overall, findings from this review suggest that MST was the most effective treatment, with six out of seven (85%) studies demonstrating a significant reduction in recidivism versus the control group. Multisystemic therapy is most effective at reducing the risk of recidivism for complex cases where youth are charged with more serious crimes (i.e., felonies and violent crimes versus misdemeanors and property crimes). The intervention MTFC also demonstrated reductions in violence compared with controls. On the other hand, FFT demonstrated a significant impact on reducing drug and property offenses, but not violent offenses (or overall offenses). This suggests that FFT may be most effective for specific offenses, potentially by improving family functioning and reducing substance use risk factors. One exception was the FFT-G model, which demonstrated positive effects on recidivism for youth at high risk for gang involvement. This suggests that a version of FFT-G may be beneficial for higher risk populations and could be tailored to target specific risk factors associated with gang involvement. Taken together, these findings also confirm the utility of tailoring treatments to meet the criminogenic needs and risk factors of individual youth, as well as saving more intensive treatments (like MST and FFT) for the highest risk and highest need youth. This is in line with the Risk, Need, Responsivity (RNR) model,60,61 which focuses on reducing the risk of recidivism by targeting individual factors that are specifically related to a youth’s offending behavior. The model is used in many juvenile justice settings.

Multisystemic therapy also evidenced notable reductions in the risk for long-term recidivism, with at least one MST study demonstrating improvement even 25 years posttreatment. Reductions in recidivism were noted for over one year for both FFT and MTFC, with some evidence for greater impact with longer term follow-up for MTFC. More research is needed to disentangle the impact of treatment from other confounding factors in the intervening years, including the natural tendency of antisocial behavior to decrease with age.62 This is still a promising finding and suggests that the positive impact of such treatments may continue into a youth’s adulthood. Randomized controlled trials were used in all of the MST and MTFC studies with positive long-term outcomes, providing further evidence for the strength of these studies.

Fewer MST studies in this review examined short-term outcomes, likely because these outcomes were examined in studies that predated our review. In the only MST study with no significant results, outcomes were assessed at six months, the most proximal time from treatment. Mixed results were also found in MTFC recidivism outcomes at 12 and 24 months, particularly for administrative outcomes, such as criminal referrals. The lack of consistent findings for both MST and MTFC within this time frame suggests that it is important to assess additional factors beyond mental health, particularly during the first 12 months of treatment. This is especially true for youth receiving interventions after being released from a residential setting, as the year following release from detention or incarceration is a crucial time for intervention.10 Similarly, for FFT, the most significant reductions in recidivism measures were found during months 7 to 18, but not during the first six months. This delayed treatment effect may have both clinical and policy implications, such as the need for ongoing support and monitoring beyond the typical length of treatment.

Although fidelity to treatment was reportedly assessed in just over half of the studies included, details were only provided in 25.8 percent of the studies. In one of these studies, FFT significantly reduced recidivism for youth in the high, but not low, therapist adherence group. This highlights the need for a greater focus on treatment fidelity in both research and clinical work, including more enhanced training for clinicians to improve adherence to evidence-based models.

Lesser Known Interventions

Family Group Conferencing

Although the FGC studies included in this review evidenced some promising results for shorter term recidivism outcomes, many of these significant effects disappeared after controlling for demographics and offense type, and there were no demonstrated long-term impacts for the FGC intervention. Unlike many of the other interventions in this review, FGC takes a restorative justice approach and does not specifically target the family dynamic to elicit change. Although FGC may have benefits beyond recidivism, the results here suggest that combining FGC with another, more targeted family-based intervention might be beneficial when reduction of recidivism is the desired outcome.

Other Interventions

The remaining lesser known interventions demonstrated some promising results, particularly regarding risk for reoffending and more severe charges. Some of these interventions included parent involvement paired with other components, making it difficult to isolate the direct impact of the parent-focused component. The majority of studies in this group of interventions were quasi-experimental (83%). Although quasi-experimental studies are commonly used in real-world settings, it is challenging to compare the findings from such studies with those evaluating more widely known interventions using an RCT design. There were also fewer studies in this category of interventions, making it difficult to draw valid conclusions about the effectiveness of individual treatment models.

Limitations and Future Directions

Our review has several notable strengths. For example, we did not limit our review by type of intervention, allowing for the inclusion of studies that examined promising but lesser known treatment models. Our search process also led to the inclusion of a sizeable number of studies, and more than half of those studies utilized a randomized control design.

Despite these strengths, several limitations should also be noted. First, because only a quarter of the included studies performed quantitative fidelity assessments, it is impossible to know whether many of the interventions were delivered as intended for the majority of included studies. This was particularly true for lesser known interventions, for which fidelity assessments may not have been developed. Many youth did not complete their assigned intervention, leading to increased risk of bias related to deviations from intended interventions and, to a lesser degree, missing data. Further, the use of a delinquency construct increased risk of selective reporting in some studies, and other analyses were at times complex and not well described.

Regarding the systematic review overall, we only included peer-reviewed journal articles, which excludes any studies or data that may be in process or unpublished. Second, although 31 studies were included, there were six sets of two studies, and one set of three studies, that utilized the same sample. Third, all but one of the included studies were in community-based settings. Although this is understandable, given the structure of family-based interventions, it still excludes youth in detention and carceral settings who may be at highest risk for further justice involvement. The absence of a standard research protocol limits the ability to directly compare studies with different methodological approaches.

Several recommendations for future research emerged from this review. First, just over half of the included studies used well known interventions, but there is evidence to suggest that some lesser known interventions may hold promise. Additional studies with methodologically sound designs are needed to generate conclusions about the effectiveness of such interventions. The availability of a wider variety of evidence-based interventions, including those that enable families at all stages of the justice system to participate, could increase both engagement and accessibility to family-based treatment. Thus, this is an especially important area for future study. Second, future research is needed to expand our understanding of the most effective family-based interventions for youth entering the juvenile justice system for the first time and for those in carceral settings. Third, given the lack of focus on therapist adherence to treatment in many of the studies included here, future studies should both measure and include fidelity to treatment when assessing the impact of family-based interventions on youth outcomes. Clinical training on these interventions should also include ongoing monitoring of fidelity to treatment.

Conclusion

Despite evidence that family-based interventions can improve many youth behavioral problems associated with justice involvement, few systematic reviews have examined the impact of such interventions on reducing youth recidivism, particularly for interventions that are newer or lesser known. This review corroborates prior research on the effectiveness of well known interventions for reducing recidivism, particularly for more serious charges, and highlights lasting impacts following intervention. The findings also highlight how some interventions may be most effective for particular groups and offense types. This review found promising results for lesser known interventions, although these would benefit from further evidence and randomized control trials. Overall, findings underscore the need for more research in this area, particularly regarding girls, minoritized youth, first-time offenders, and youth in carceral settings.

Acknowledgments

The authors would like to acknowledge Fei Guo, MS for her expert statistical consultation as well as medical librarians Dorice L. Vieira, MLS, MA, MPH and Gregory Laynor, MLS, PhD for their assistance during the literature search process.

Author K.K.A. was supported in part by Grant No. H79SM080388 from the American Psychiatric Association Foundation’s Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellowship Program. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Service, American Psychiatric Association, or American Psychiatric Association Foundation. Mention of trade names, commercial practices, or organizations does not imply endorsement by the U.S. Government.

Footnotes

  • Disclosures of financial or other potential conflicts of interest: None.

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In this Issue

Journal of the American Academy of Psychiatry and the Law Online

Vol. 54, Issue 3

1 Sep 2026

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Keywords

aggression, violence, child and adolescent, jail diversion, juvenile justice