Aggression Replacement Training (ART) - a three component programme for young male juvenile offenders to teach pro-social behaviours, reduce and control aggression and promote higher level of moral reasoning
At a glance
Country of origin
- USA
Level(s) of intervention
- Indicated prevention,
- Selective prevention
Aggression Replacement Training consists of three major components: Skillstreaming, to teach prosocial behaviours; Anger Control Training, to reduce and control aggression; and Moral Education, to promote higher levels of moral reasoning. Together, these three components allow youth to not only develop prosocial values, but also learn concrete techniques promoting overt prosocial behaviour and inhibiting antisocial behaviour. The training curriculum is somewhat flexible in length, but the core components require at least 10 weeks of multiple sessions in each of the three areas.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Barry Glick
New York State Division for Youth
Phone: +1 (718) 665-5500
Overview of results from the European studies
Studies overview
The programme has been evaluated in one randomised controlled trial in Norway, and four quasi-experimental studies, one each in Norway, Sweden, the UK and Turkey.
In the RCT, 14 adolescents aged 14 to 20 years, and 25 children aged 7 to 12 years who displayed behaviour problems participated. Adolescents in the intervention group had a non-significant increase in social skills and decrease in problem behaviours, while those in the control group showed a non-significant decrease in both, social skills and problem behaviour. There was a significant improvement on social skills and problems among children in the intervention group from pre to post intervention, but a non-significant change among children in the control group. Significance of difference between groups is not reported.
The Norwegian QED included 47 youth aged 12-14 years receiving ART and 18 youths as controls. Participants in the ART group indicated significant improvement, but participants in the comparison group did not, in general, indicate improvement - the ART group demonstrated significant improvement on 9 out of 10 tests; the comparison group demonstrated improvement on 2 out of 10 tests. However, (due to a relatively small sample and ‘heterogeneous’ groups), the intervention effect (group x time interaction) was not statistically significant.
The Swedish study included 64 adolescents, with a mean age of 17 years, placed at the institutions for compulsory treatment. Two institutions administered the intervention and two served as controls. It is not mentioned how the groups were allocated. There were no significant effects, but it should be noted that all four institutions were compared rather than intervention and control groups.
The UK study was conducted with 41 adolescents aged 11 to 17 years. Non-parametric statistical tests demonstrated no significant improvements in the intervention participant’s social skills or problem behaviours.
The Turkey study was conducted with 65 adolescents, with a mean age of 16 years, from juvenile and youth prisons. The study found significant intervention effects only on 1/10 measures of anger and aggression, and on the secondary outcome of problem-solving skills.
An additional Swedish study by Larden et al. examined the effects of ART on adult offenders' criminal recidivism and found no effects of reoffending (Larden et a. 2017). The ART program is originally designed for adolescents, and it might be that the program should be adjusted for adults.
Countries where evaluated
- Norway,
- Sweden
Characteristics
Protective factor(s) addressed
- Individual and peers: clear morals and standards of behaviour
- Individual and peers: individual/peers other
Risk factor(s) addressed
- Individual and peers: other
Outcomes targeted
- Emotional well-being
- Emotion regulation, coping, resilience
- Other behaviour outcomes
- Violence
Description of programme
Aggression Replacement Training consists of three major components: Skillstreaming, to teach prosocial behaviours; Anger Control Training, to reduce and control aggression; and Moral Education, to promote higher levels of moral reasoning. Together, these three components allow youth to not only develop prosocial values, but also learn concrete techniques promoting overt prosocial behaviour and inhibiting antisocial behaviour. The training curriculum is somewhat flexible in length, but the core components require at least 10 weeks of multiple sessions in each of the three areas.
(1) Structured Learning Training, or Skillstreaming, consists of a curriculum of skillstreaming skills (a broad array of interpersonal and daily living skills) taught through modelling, role-playing, and performance feedback; moral reasoning dilemmas; and anger control training steps. Skillstreaming facilitates prosocial behaviour. The skills fall into one of six families: beginning social skills, advanced social skills, skills for dealing with feelings, alternatives to aggression, skills dealing with stress, and planning skills.
(2) Anger Control Training enables youth to control their level of anger arousal. Youth are trained to respond to their hassles with a chain of behaviours that include identifying triggers, identifying cues, using reminders to stay calm, using reducers such as deep breathing to lower the level of anger, and using self-evaluation.
(3) Moral Education increases youths' sense of fairness, justice, and concern for the right of others. Participants meet in small groups in which individuals are functioning at different levels of moral reasoning. A group leader then describes scenarios and real life situations posing moral dilemmas, and participants fully examine and discuss these scenarios and possible solutions to it.
Implementation Experiences
Contact details
Peter Bleumer
pbleumer[a]iae.nl
Tim Tiemissen
timtiemissen[a]gmail.com
Main obstacles
With respect to individual professionals
The client group is complex to work with, and this requires experience and training. New trainers, having completed a five-day course on how to deliver the intervention, have different struggles with their first aggression replacement training groups (6-10 people). The struggles new trainers often face are how to deliver the programme sensitively in the setting where they work without sacrificing too much of the programme’s integrity (i.e. following the treatment manuals), group management and trainee resistance and delivering training procedures in a methodical, correct way (usually moral reasoning training is found to be quite difficult at first, as is making effective use of cognitive-behavioural therapy techniques and effectively conducting role play).
With respect to social context
Every social structure has delimiting systemic elements that impact on how a programme can be delivered. In an enclosed forensic psychiatric setting, a floor effect (aggression is already at a high level in prison) can have an impact on how clients can benefit from the training. In schools, there is a curriculum and the programme must be made to fit that curriculum, and in outpatient clinics clients might not show up. Patients might not be intrinsically motivated to take part in the aggression replacement training. In addition, people and practitioners can be stubborn and decide to leave certain things out of the protocol that have an impact on the quality of the intervention.
With respect to organisational and economic context
Aggression replacement training remains under-researched. Conducting randomised controlled trials costs a lot of time and money and conducting research with this client group is difficult because of high dropout rates. Motivating organisations to monitor programme effects remains a challenge.
How they overcame the obstacles
With respect to individual professionals
There are programme integrity checklists, and new trainers can receive coaching on the job. Twice a year, aggression replacement trainers come to a supervision day during which their aggression replacement training skills are fine-tuned and kept ‘on model’.
With respect to social context
When a new organisation starts aggression replacement training, we take extra care to develop a package that fits not only the context but also the specific client group to which it is delivered. As a result, we spend time with programme mangers helping them plan ART sessions, helping with pre- and post- measurements and setting up a supervision structure within the organisation to take care of trainers (because it’s quite complex working with people with aggression problems).
With respect to organisational and economic context
Try to keep an open mind and encourage people to work together instead of seeing one another as competitors.
Lessons learnt
With respect to individual professionals
Giving new trainers the support that they need and modelling and practising with effective training/treatment procedures helps new ART practitioners gain confidence and experience success in delivering the treatment.
With respect to social context
So many people have been trained in various settings. Keeping in contact with these people is a challenge but is important to maintain or attain a level of congruence in the way aggression replacement training is delivered. In addition, there needs to be a balance between wanting to share our material and giving people the freedom to add to it, making it fit in their organisational context and maintaining programme integrity.
With respect to organisational and economic context
Try to emphasise the value of treating aggressive behaviour over competing in a healthcare market (the term says enough).
Strengths
- Paying attention to participants motivation and their social support to take part in aggression replacement training reduces drop out.
- Modelling training procedures and practising them makes new aggression replacement trainers more competent than when they just talk about doing it.
- Working together with different service providers helps set the stage for intervention success.
- Making use of the programme integrity checks keeps you on model as a trainer.
- Evaluating intervention participants and scoring and discussing changes in aggressive behaviour halfway through the intervention helps participants finish the full programme.
- Practising difficult client encounters through role play helps you deal with them in the real word.
Weaknesses
- It is difficult to stay in contact with everyone we have trained.
- It is difficult to maintain programme integrity when so many different institutions are delivering ART.
- It is hard to motivate institutions to evaluate programmes.
Opportunities
Aggression replacement training is delivered all over the world. However, it remains understudied (in the sense of methodological quality), and this is an opportunity. It would be great if the presupposed working principles would be systematically tested using experimental or quasi-experimental designs.
Threats
People tend to favour developing something new over first researching whether that something works in the first place. Methodologically sound research on ART is needed before we start to change the intervention.
Recommendations
With respect to individual professionals
Always work in couples; make sure the organisations provide a room to deliver the training and the necessary materials and also time, etc.
With respect to social context
Really try to engage the client group and pay attention to motivational problems prior to delivering the intervention. Try to get people around the client involved in the treatment, i.e. a partner or parent who can give a client positive feedback when they succesfully employ what they have learnt in aggression replacement training.
With respect to organisational and economic context
Try to get people around the client involved in the treatment, i.e. a partner or parent who can give a client positive feedback when they succesfully employ what they have learnt in aggression replacement training.
