HHS Public Access Author manuscript Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. A u t Published in final edited form as: h o Cogn Behav Pract. 2013 May ; 20(2): 171–188. doi:10.1016/j.cbpra.2012.06.003. r M a n u Development of the Juvenile Justice Anger Management s c rip Treatment for Girls t Naomi E. S. Goldstein, Jennifer M. Serico, Christina L. Riggs Romaine, Amanda D. Zelechoski, Rachel Kalbeitzer, Kathleen Kemp, and Christy Lane Drexel University A Abstract u t h Female juvenile offenders exhibit high levels of anger, relational aggression, and physical o r aggression, but the population has long been ignored in research and practice. No anger M a management treatments have been developed specifically for this population, and no established n u anger management treatments are empirically supported for use with delinquent girls. Thus, to s c alleviate anger and reduce the frequency and severity of aggressive behaviors in this underserved r ip population, we developed the gender-specific, Juvenile Justice Anger Management (JJAM) t Treatment for Girls. This cognitive-behavioral intervention was adapted from the Coping Power Program (Lochman & Wells, 2002), a school-based anger management treatment for younger children that has established efficacy and effectiveness findings with its target populations. This paper describes how the content of JJAM was developed to meet the unique needs of adolescent girls in residential juvenile justice placements. It also traces the process of developing a A manualized treatment and the steps taken to enhance efficacy and clinical utility. An overview of u t h the treatment, a session-by-session outline, an example session activity, and an example homework o r assignment are provided. A randomized controlled trial is currently being conducted to evaluate M a the efficacy of the JJAM Treatment for Girls. n u s c r ip Keywords t female juvenile offenders; anger management; intervention; juvenile justice; aggression Juvenile offenders display high levels of anger and aggression when compared to their non- delinquent peers (Sukhodolsky & Ruchkin, 2004), and youth who display these characteristics often have other adjustment problems (Borduin & Schaeffer, 1998; Tarolla, A Wagner, Rabinowitz, & Tubman, 2002). Aggression has been identified as the strongest u th predictor of social adjustment problems in children (Crick & Grotpeter, 1995; Crick, Ostrov, o r M a n u Address correspondence to Naomi E. S. Goldstein, Ph.D., Department of Psychology, Drexel University, MS 626, 1505 Race Street, s Philadelphia, PA, 19102; [email protected]. c r Christina L. Riggs Romaine is now at Essex County Juvenile Court. Amanda D. Zelechoski is now at the Department of Psychology, ip Valparaiso University. Rachel Kalbeitzer is now at the Nebraska Department of Correctional Services. Kathleen Kemp is now at the t Institute of Law, Psychiatry, and Public Policy, University of Virginia. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Goldstein et al. Page 2 & Werner, 2006), and anger and aggression are linked to negative outcomes, such as truancy, A substance use, destruction of important relationships, violence, and delinquency—problems u th that can continue into adulthood (Borduin & Schaeffer; Kokko & Pulkkinen, 2000). These o r negative outcomes highlight the need for effective anger management and aggression M reduction interventions for juvenile offenders. In addition to the clinical need, there also is a a n legal need for anger management treatment for this population. Juvenile offenders are u s frequently mandated to complete anger management treatments as part of their dispositions c r ip from juvenile court (Lane, Lanza-Kaduce, Frazier, & Bishop, 2002). Despite the clinical and t legal importance of having an effective anger management treatment available, few empirically supported treatments exist for juvenile offenders (Office of Juvenile Justice and Delinquency Prevention [OJJDP], 2008). Studies examining gender differences in anger among adults from community and clinical samples have shown somewhat contradictory results; some studies revealed no differences A u (e.g., Archer, 2004; Campbell & Muncer, 2008), yet others identified differences in the t h o causes and expression of anger (e.g., Fischer & Evers, 2011; Kassinove, Sukhodolsky, r M Tsytsarev, & Solovyova, 1997). For example, women were more likely than men to express a anger in the home and to report being angered by someone they loved (Kassinove et al., n u s 1997). Findings from studies on gender differences in youths’ anger also appear to be c r somewhat mixed (Zeman & Garber, 1996), although some gender discrepancies have been ip t identified, such as findings that middle school–aged girls experience concurrent anger and depression more often than do boys (DeCoster & Zito, 2010). There also appear to be important gender differences in the expression of aggression among juvenile offenders. Although some studies have found that boys display higher levels of aggression than girls, others have suggested that, when both physical and relational A aggressions are considered, girls may demonstrate similar levels of aggression as boys u t h (Moretti & Odgers, 2002). Relational aggression, which is a type of aggression that damages o r or threatens to damage relationships or social standing (e.g., spreading rumors, excluding M a someone from a group, giving someone the silent treatment), is often understood as a n u gender-specific form of aggression, with higher rates seen among girls than boys (Crick & s c Grotpeter, 1995). Female juvenile offenders display significant amounts of both physical and r ip relational aggression, behaviors that are related to concurrent and future internalizing and t externalizing problems in girls (Crick & Grotpeter; Crick et al., 2006). Gender differences in aggression have been noted in both the expression of aggression (i.e., physical v. relational) and development of aggression (Loeber & Stouthamer-Loeber, 1998). Further, girls are more likely than boys to act aggressively in the home (Zahn et al., 2008) and against friends and family members (Loper, 2000). A u t Juvenile offenders who are placed in residential juvenile justice facilities are typically h o housed with other youth of the same gender, and research suggests important differences r M between male and female offenders that have implications for their treatment (Calhoun, a n 2001). Gender-specific data on the prevalence of anger and aggression among juvenile u s offenders revealed that 54% of girls in a juvenile justice sample reported substantial c r ip problems with anger (Grisso & Barnum, 2000). Further, a significant proportion of the t offenses for which female youths are arrested are associated with anger and anger-related Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. Goldstein et al. Page 3 behaviors, such as physical and relational aggression (Snyder, 2002), highlighting the need A for anger management and aggression reduction treatment for female juvenile offenders. u th However, to our knowledge, no empirically supported treatments exist for girls in residential o r juvenile justice placements. M a n In response to the clinical and legal need for anger management and aggression reduction u s treatments, the authors developed the Juvenile Justice Anger Management (JJAM) c r Treatment for Girls. JJAM is an empirically based, gender-specific, manualized treatment ip t that was developed to meet the unique needs of adolescent girls housed in residential juvenile justice facilities. In this paper, we describe the development of the JJAM treatment content and discuss the ways in which we tailored the treatment to the specific needs of this population. We then review the process of developing the JJAM treatment manual, which began with an initial adaptation of Lochman and Wells’s (2002) Coping Power Program1 (CPP) and is culminating in an ongoing randomized controlled trial (RCT) of the JJAM A u treatment. Although RCT results are not yet available, this paper describes the steps involved t h o in developing a manualized treatment that is clinically sensitive to individual clients’ needs r M and, simultaneously, seeks to ensure the broad clinical utility and fidelity of the intervention. a n u s Development of JJAM Treatment Content c r ip To address the clinical and legal needs of female juvenile offenders, we emphasized a variety t of factors in JJAM that are specific and relevant to the population. Lochman and Wells’s (2002) CPP was an appropriate starting framework for an anger management treatment for female juvenile offenders because (a) the CPP reflects the literature on childhood aggression; (b) session activities, homework assignments, and interactive teaching techniques are designed to facilitate skill acquisition; and (c) the CPP has been studied and A found effective with other populations (Goldstein, Dovidio, Kalbeitzer, Weil, & Strachan, u th 2007). The CPP is a multicomponent intervention designed for pre- and early-adolescent o r youth with anger and aggressive behavior problems and has been found efficacious at M reducing aggressive behaviors in boys, ages 8 to 15 (e.g., Lochman & Curry, 1986; a n u Lochman, Lampron, Gemmer, Harris, & Wyckoff, 1989; Lochman & Wells, 2003). s c rip In creating JJAM, we included gender-specific adaptations to the CPP, including expanded t instruction on relational aggression and skill-building in the areas of developing, strengthening, and repairing relationships. JJAM also included adaptations to the CPP so that the treatment would be developmentally and culturally appropriate for adolescent girls in the justice system. In addition, facilitator techniques were added to manage behavioral problems and to increase positive participation. Finally, we designed the treatment to A accommodate the settings in which JJAM is intended to be delivered, namely, residential u t juvenile justice facilities. h o r M a n u s c r ip t 1Adaptations actually were made to the Anger Coping Program (Lochman, FitzGerald, & Whidby, 1999), an earlier version of the CPP. However, for consistency and ease of communication, the treatment name, CPP, is used throughout this paper. Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. Goldstein et al. Page 4 Conceptual Model of JJAM A u When managing anger, individuals must regulate emotions to reduce arousal. Aggressive t h children demonstrate social information processing (SIP) deficits in encoding, attributions, o r social goal setting, accurate outcome expectations, solution generation, decision making, M a and enacting behavioral solutions (Crick & Dodge, 1994). When anger-producing stimuli n u generate arousal, children may focus on perceived threats and impulsively respond with s c physical or relational aggression, believing that their behaviors will lead to positive results r ip (Lochman et al., 1999). Many successful anger management interventions (e.g., Goldstein, t Glick, & Gibbs, 1998; Kusche & Greenberg, 1995; Webster-Stratton, Reid, & Hammond, 2004), including the CPP, aim to prevent the negative effects of anger, particularly aggressive behaviors, by teaching cognitive and behavioral techniques to reduce arousal and enhance SIP skills (Crick & Dodge, 1994). Consistent with the established approaches and the unique needs of delinquent girls, JJAM retained the key mechanisms of action included A in the CPP program: emotional regulation, cognitive restructuring of hostile attributions, and u t h social problem-solving skills. o r M Given the emphasis on identified mechanisms of action, we expected that delinquent girls’ a n participation in JJAM would improve their emotion regulation and social problem-solving u s skills and reduce hostile attribution biases. These cognitive and behavioral improvements c r ip should, in turn, result in less anger and aggression, which should be associated with lower t rates of recidivism, as well. In addition, because many of JJAM’s central components mirror those of effective treatments for oppositional-defiant disorder, conduct disorder, anxiety, and depression (e.g., Henggeler, Schoenwald, Borduin, Rowland, & Cunningham, 1998; Suveg, & Zeman, 2004; Zeman, Shipman, & Suveg, 2002), we expected to see reductions in externalizing and internalizing symptoms as core anger and aggression symptoms decrease A (Burke, Loeber, & Birmaher, 2004). See Figure 1 for the theoretical model underlying u t JJAM. h o r M Generally, the role of anger in aggression has been considered strong for youth and adults a (Novaco, 1997). However, the relationship between anger and aggression has been debated n u in recent years, particularly for adult offenders. Few studies have been conducted on anger s c r management interventions with adults in the criminal justice system, and those extant ip t studies have produced mixed treatment outcome results (Dowden, Blanchette, & Serin, 1999; Watt & Howells, 1999). These findings have led to discussions of the impact of treatment readiness and levels of anger on treatment outcomes (Howells et al., 2005). Anger management treatments with adult offenders may not be effective because, unlike juvenile offenders (Goldstein et al., 2007), adult inmates may not display high levels of anger at pretreatment (Heseltine, Howells, & Day, 2010). Such differences between adolescent and A u adult offenders’ levels of anger and aggression may explain differences in treatment t h o responsiveness and overall treatment outcomes. r M a In contrast to the mixed results with adult offenders, research has suggested that anger n u management treatment may prevent aggressive behaviors among adolescents (Nelson, Finch, s c & Ghee, 2006), diminish the probability of negative consequences (Lochman, Powell, r ip Whidby, & Fitzgerald, 2006), and reduce the high rates of recidivism typical in this t population (Goldstein, Nensen, Daleflod, & Kalt, 2004; Kazdin, 1987). Although anger Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. Goldstein et al. Page 5 management treatment may reduce aggressive behaviors, the role of anger in the expression A of aggression remains somewhat unclear, and it is likely that not all aggression (e.g., u th instrumental aggression) arises from feelings of anger. However, given that juvenile o r offenders are often court-mandated to anger management treatment, and evidence suggests M that anger frequently mediates aggressive reactions among juvenile offenders (e.g., Cornell, a n Peterson, & Richards, 1999), the treatment of anger to reduce aggression represents an area u s worthy of clinical and empirical attention. c r ip t JJAM Content Specific to Female Juvenile Offenders Instruction on Relational Aggression—One important adaptation when creating the JJAM manual was to incorporate specific instruction on relational aggression. This focus was of particular importance because, in addition to exhibiting physical aggression, girls frequently manifest anger through relational aggression (Crick & Grotpeter, 1995). A Emphasis was placed on helping participants understand that relationally aggressive acts u th (e.g., excluding others, spreading rumors, giving the silent treatment) may have some of the o r same negative consequences as physically aggressive acts, as well as unique consequences, M such as loss of friendships, loss of support during physical fights, and damage to family a n relationships. The direct relationship between physical and relational aggression also was u s c addressed in this context. JJAM specifies that many of the coping strategies that are r ip employed to prevent physical aggression should be used when girls feel the “urge” to be t relationally aggressive. In addition to entire sessions focused on relational aggression, we incorporated relational aggression examples into all relevant activities and discussions throughout the manual. Skills to Repair Damaged Relationships and to Initiate and Strengthen A Positive Relationships—Girls’ aggression tends to be associated with conflictual u t interpersonal relationships. Girls are more likely than boys to commit crimes against friends h o or family members (Loper, 2000; OJJDP, 2008), and damaged relationships cause more r M distress for girls (Gavin & Furman, 1989). In addition, girls’ violence more often occurs at a n home, while boys’ violence more often occurs away from home (Zahn et al., 2008), a pattern u s that also may be related to girls’ greater tendencies toward relational aggression (Murray- c rip Close, Ostrov, & Crick, 2007). Furthermore, when compared to boys with similar problems, t girls with disruptive behavior disorders experience more peer rejection due to poorer social functioning (Carlson, Tamm, & Gauh, 1997; Cohen, 1989). To address these gender-specific issues, JJAM incorporates sessions on strengthening and repairing damaged relationships. During treatment, girls are asked to consider how their previous aggressive acts damaged valued relationships. They are encouraged to take specific A u steps towards healing some of these strained relationships, including writing formal apology t h o letters to people they may have hurt in the past. Throughout the sessions, participants are r M encouraged to take responsibility for their actions by recognizing the impact of their a behaviors on others, as well as on themselves. In addition, we added the teaching of adaptive n u social skills (e.g., learning to initiate conversations, showing positive regard for others, being s c r a good friend, appropriately expressing dissatisfaction with others’ behavior) to help ip t participants establish and maintain positive peer relationships. Further, because girls’ Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. Goldstein et al. Page 6 aggression often occurs in the home, JJAM provides numerous opportunities to discuss A anger-producing situations in the home and to practice reactions to these situations through u th role-play activities. Group participants are encouraged, throughout every session, to provide o r examples of their anger and aggression within and outside of the residential juvenile justice M facilities, and the topic of aggression in the home is particularly salient during sessions and a n activities that focus on relationships. An activity is included to help youth inform family and u s closest friends about the skills that they learn during JJAM in order to promote the c r ip generalization of skill use to the home environment. t Developmental Appropriateness—Interventions demonstrate better outcomes when designed to address the developmental stage of their target populations (Dusenbury, Falco, Lake, Brannigan, & Bosworth, 1997), and, therefore, the JJAM treatment manual was adapted to meet the developmental needs of female juvenile offenders in residential A placements. The CPP was designed for boys, ages 8 through 12, so most teaching materials u t and activities in JJAM were developed to reflect situations likely to be encountered by h o teenage girls. JJAM needed to directly and thoroughly address a number of topic areas r M relevant to adolescent females, including coping with romantic breakups; managing a n jealousy; dealing with social status threatened by other girls; and improving contentious u s relationships with teachers, parents, and facility staff members. JJAM was designed for c rip delinquent girls ages 12 to 19, and the manual provides flexibility to allow facilitators to t generate examples of situations appropriate to the developmental level of a specific group’s members. Throughout the manual, JJAM encourages group leaders to use, as examples, the real-life, anger-provoking situations described by participants. Cultural Sensitivity—Ethnic minorities are overrepresented in the juvenile justice system (Piquero, 2008). In addition, many juvenile justice youth experience poverty and are unable A u to access basic resources, such as adequate housing, health care, nutrition, and education t h o (McKinnon, 2003). With this absence of basic needs fulfillment, many juvenile justice r M youths have developed mistrust of authority figures and adults in helping professions, a something that has been cited as a major barrier to effective treatment (Huang et al., 2005). n u To address this issue, JJAM was developed to help group leaders build strong, therapeutic s c r relationships with adolescent clients from a variety of cultures and backgrounds. Group ip t leaders are taught to use appropriate self-disclosure to build rapport and facilitate communication within treatment groups (Sue & Sue, 1999); educate youth about facilitators’ roles, participants’ roles, and the therapeutic process; emphasize and maintain confidentiality; and address and acknowledge cultural differences and tensions. Comorbid Mental Health Symptoms—To address the high rates of comorbid mental A u health symptoms in female juvenile offenders (Teplin, Abram, McClellan, Dulcan, & t h Mericle, 2002), JJAM draws from traditional cognitive-behavioral therapy (CBT) o r approaches and uses techniques such as cognitive restructuring and problem solving. The M a intervention increases the emphasis on reducing negative approaches to emotion regulation n u (e.g., catastrophizing, self-blame) and decreases the emphasis on positive emotional s c appraisals (e.g., positive refocusing). This shift in emphasis was due to JJAM’s prioritization r ip of accurate appraisals in the cognitive restructuring and social problem-solving processes. t Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. Goldstein et al. Page 7 Because of the high prevalence of traumatic histories (Hennessey, Ford, Mahoney, Ko, & A Siegfried, 2004), unpleasant juvenile justice placements (Sedlak & McPherson, 2010), and u th obstacles to successful futures (Clinkinbeard & Zohra, 2011), delinquent girls’ accurate o r appraisal processes need to reflect difficult and painful realities. It can be difficult to M distinguish automatic thoughts that represent distortions of reality from those that reflect a n realistic appraisals of truly negative realities. When participants express these realistic u s appraisals, JJAM emphasizes acceptance of negative realities and challenges unrealistic, c r ip optimistic reframing approaches. Girls are encouraged to prepare for negative realities and, t instead of emphasizing positive outcomes, a balanced perspective is encouraged through the use of cognitive restructuring techniques (e.g., evaluating evidence on each side of the issue). In response to negative realities, JJAM leaders also emphasize problem-solving strategies to help participants manage difficult situations. A Methods of Managing Inattention, Hyperactivity, Impulsivity, and Low u t Cognitive Functioning—Compared with nonoffending youth, female juvenile offenders h o demonstrate poorer cognitive functioning and have higher rates of illiteracy and attention- r M deficit/hyperactivity disorder (ADHD; Lexcen & Redding, 2000). In a large juvenile justice a n study, 21.4% of girls were diagnosed with ADHD, while only 16.6% of boys met the same u s diagnostic criteria (Teplin et al., 2002). To address these behavioral and cognitive issues, the c rip JJAM manual includes adaptations to provide effective teaching strategies when working t with this population. Group facilitators are trained to deal with hyperactivity, attention deficits, and disruptive behaviors by administering immediate, frequent, and salient feedback for positive and negative behaviors. Reminders to provide such feedback were specifically written into the manual. Didactic lecturing was minimized, and hands-on, interactive teaching activities were included throughout JJAM to help maintain the attention of participants. To compensate for the high rates of illiteracy and lower cognitive functioning, A u activities were modified to require very little writing and reading by participants. The t h o language throughout the manual was simplified; the average Flesch-Kincaid reading level of r M the material that facilitators read to participants was reduced to fifth grade, with a Flesch a n Reading Ease Score of 83, which is considered “easy” (Fielding, 2006; Flesch, 1948). The u s materials read by participants were reduced to a Kindergarten reading level, with a Flesch c r Reading Ease score of 97.4, which is considered “very easy,” around the level of a comic ip t book. Techniques to Encourage Positive Participation—Group facilitators are trained in strategies to increase participation, such as praising youth who volunteer to participate, reducing fears of “looking stupid” by rewarding even minimal attempts to use anger management strategies, providing reluctant youth with scripts for role-plays to reduce A u performance anxiety, and providing imperfect modeling of new skills by group co-leaders to t h o make it easier for youth to risk subperfect performances while learning new skills. In r M addition, individual and group incentive programs were created to encourage attendance, a appropriate group interactions, and completion of assignments. Participants earn points each n u session for attending and staying throughout the session, following the group’s rules, and s cr constructively participating and completing homework goals2 for skills practice. These ip t points can be traded in for tangible rewards or privileges at the end of each session or saved Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. Goldstein et al. Page 8 for upcoming sessions. In addition, to promote group participation and foster encouragement A and reinforcement between participants, a group pizza party was added as a group-level u th incentive. o r M Conforming to Juvenile Justice Facility Regulations—Given the frequency of a n iatrogenic effects of residential juvenile justice placements (Redding, Lexcen, & Ryan, u s 2005), JJAM was designed to promote anger management skills, reduce physical and c rip relational aggression, and decrease recidivism rates for girls in these settings. Therefore, the t final, major manual adaptation involved adjusting the treatment to conform to residential juvenile justice facilities’ rules and guidelines. Goals and homework tasks, as well as the behavioral management system and session activities, needed to adhere to facility guidelines and be approved by administration and staff. These adaptations were designed so that JJAM would fit the regulations and guidelines of most juvenile justice facilities. Nonetheless, A flexibility was built into the manual so that JJAM could meet the rules and regulations of u t specific sites. For example, the JJAM manual includes a sample point list for rewards and h o specifies a process for establishing a reward-point list tailored to individual facilities. r M a n Overview of the JJAM Treatment u s The JJAM treatment is the result of multiple rounds of revisions to incorporate information c r ip from a pilot study, results of focus groups, feedback from an expert review panel, and a t small initial trial of the JJAM treatment. The process of development is described in detail below. JJAM is a 16-session, manualized group treatment for female offenders in residential juvenile justice facilities. The treatment groups are facilitated by two leaders, and 90-minute sessions are held twice weekly for 8 weeks. The JJAM treatment uses a cognitive-behavioral A u framework and relies on established techniques, such as cognitive restructuring, skills t h o training (e.g., emotion regulation, coping, social, and communication skills), and problem r M solving. The first three sessions emphasize the distinction between anger and aggression, a and these sessions help participants differentiate between emotions and behaviors, identify n u consequences of aggression, and understand the concept of relational aggression. The next s c r session is devoted to changing appraisal processes using perspective-taking and other ip t cognitive restructuring techniques, followed by sessions designed to promote participants’ abilities to identify their physiological signs of anger and triggers of anger. The next phase of treatment is devoted to coping skills training, followed by sessions that focus on problem- solving skills and relationships. The final sessions are designed to help participants generalize skills to new situations and other settings and to make skills accessible for future use. Table 1 provides a more detailed description of the theory and purpose of each JJAM A u session. t h o r Each session is formatted similarly, as structural predictability fosters learning and skills M a acquisition (Mazur, 2006). At the beginning of each session, each participant reviews her n u s c r ip 2In the context of JJAM, “goals” refers to homework targets that involve skills practice and rehearsal, and “goal sheets” refers to t “homework assignments.” We avoid using the term “homework” when talking with juvenile justice youths, given their frequency of school failure and negative feelings about school assignments (Hinshaw, 1992; McEvoy & Welker, 2000). Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. Goldstein et al. Page 9 goal sheet from the previous session. The goal sheet documents the ways in which the A participant practiced the assigned skill since the previous session. Skills practice is a critical u th component of successful treatment, facilitating skill mastery and increasing the accessibility o r of skills for use in real-life situations (Mazur). Following the review of goal sheets, the M previous sessions are reviewed. This review is accomplished by prompting participants for a n rhyming catch phrases taught during the previous sessions (e.g., “Just like a physical fight, u s being mean isn’t right”) and showing visual aids (e.g., a cartoon of two children fighting) c r ip that also were introduced during the previous sessions. This fun and repetitive review is t designed to enhance accessibility of previous sessions’ critical material for future use. Next, we facilitate two to four creative, age-appropriate activities that we developed for each session to teach the session’s content and practice the associated skills. Activities include performing role-plays, playing games, analyzing movie clips, and doing arts and crafts projects. With practice, the skills learned should become more accessible for use when the A participant experiences anger in the future. u t h o Although the treatment is manualized, flexibility also is built into JJAM. Examples of anger- r M producing and aggression-provoking situations are elicited from participants and a incorporated into every session. Participants are encouraged to provide examples from their n u s lives, and emphasis is placed on using examples of both physical and relational aggression. c r At the end of each session, individual goals that involve skills practice are established, and a ip t plan to complete each goal is created to increase the likelihood of practice completion. The group facilitators summarize the information and skills taught in the session and present the rhyming catch phrase and visual aid. Finally, individual and group participation points are calculated and recorded; points can be traded in for tangible rewards or privileges. Individual incentives are designed to encourage participants to attend sessions, cooperate and participate during the sessions, complete the homework assignments, and comply with A u behavioral goals. Group incentives are designed to encourage positive peer pressure toward t h o the same ends. Key features of the treatment and manual can be seen in the sample session r M activity provided in Appendix A, which demonstrates a game used to teach cognitive a restructuring skills, and in the sample goal sheet provided in Appendix B. n u s c r Process of JJAM Development ip t The treatment manual was created using a structured set of steps designed to generate a systematic development process with rigorous evaluation (see Figure 2). Treatment manual development began with initial adaptations to the CPP and is culminating in a RCT of the JJAM treatment. Although at the time of this writing the RCT was not yet complete, the following description tracks the steps involved in creating a manualized treatment for A delinquent girls in residential juvenile justice facilities. This description is intended to offer a u th practical example of the process of adapting an existing treatment to meet the needs of a o r specialized population. For a more detailed discussion of and guidelines on adapting a M treatment manual for use with specific populations, see Goldstein, Kemp, Lochman, and a n Leff (2011), and for more general guidelines on manual development, see Carroll and Nuro u s c (2002) or Onken, Blaine, and Battjes(1997). r ip t Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16. Goldstein et al. Page 10 Adapted the CPP to Create the Anger Management Treatment for Female Juvenile A Offenders u t h In order to make the CPP appropriate for use with delinquent girls, adaptations were made to o r the established treatment manual, resulting in the first iteration of JJAM, titled the Anger M a Management Treatment for Female Juvenile Offenders (AMFJO; Goldstein et al., 2007). n u The CPP topics were largely maintained, but specific activities were changed to make them s c culturally, developmentally, and gender appropriate, in addition to making them appropriate r ip for use in juvenile justice facilities (e.g., included examples of multicultural girls instead of t white boys, youth developed and performed a play instead of making a movie due to privacy issues regarding the recording of youth in justice facilities). In addition, to incorporate a key piece of the girls’ aggression literature, we added one session specifically focused on relational aggression. AMFJO, the initial, revised version of the CPP, was the first attempt at a manualized anger management treatment for female juvenile offenders. Changes were not A exhaustive of those needed; rather, an initial version of a treatment manual was created that u t h would be usable with this population in a pilot study. o r M AMFJO included 18, 90-minute sessions facilitated by a leader and co-leader over 9 weeks a n in a female, post-adjudication, juvenile justice facility. Sessions were structured similarly to u s those of the current JJAM treatment, including reviews of previous sessions, introduction of c r ip new materials, and provision of tangible reinforcement for participants. t Pilot Study of AMFJO A pilot study was designed to examine: (a) how the proposed theoretical model applied to delinquent girls in residential placement; (b) whether the methods of assessing differences between AMFJO and the treatment-as-usual (TAU) control condition were appropriate; (c) a A very rough estimate of effect size of outcome differences between AMFJO and TAU; (d) u t whether youth understood the critical pieces of information and found the group activities, h o r homework, and program materials appropriate, acceptable, and engaging; (e) youths’ M likelihood of regular attendance and homework completion and receptiveness to a behavioral a n management/incentive program; (f) potential obstacles to treatment success; and (g) other u s topics youth felt were relevant to managing anger and aggression that were not included in c r ip the treatment. t The adapted AMFJO treatment was piloted with a small sample of female juvenile offenders, as described in detail in Goldstein et al. (2007). Participants (N = 12) were delinquent girls, ages 14 to 18 (M = 15.8, SD = 1.3), in a post-adjudication facility, whose offenses included repeated truancy, drug charges, theft, trespassing, and assault. Facility housing units were randomly assigned to either the TAU + AMFJO condition or TAU. A u t h At pretreatment, all girls in the pilot study scored in the clinical range on the Aggression o r Questionnaire (AQ; Buss & Warren, 2000), which measures physical aggression, verbal M a aggression, indirect aggression, hostility, and anger, and received at least one mental health n u diagnosis on the NIMH Computer-Diagnostic Interview Schedule for Children (C-DISC; s c Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000). Results revealed medium to large r ip t Cogn Behav Pract. Author manuscript; available in PMC 2016 September 16.