New
York:
Random House, Inc;
ISBN 0-375-50809-0 271 pages, $25.95 |
Last
Chance in Texas: The Redemption of Criminal Youth
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by
John Hubner
Reviewed
by David L Chadwick, MD
|
Last
Chance in Texas is about a way some teenagers who have committed
serious crimes can be habilitated and re-enter society with a very low
risk of recidivism. It holds interest for health providers for several
reasons.
John Hubner's
factual account underscores the fact that virtually all delinquent youths
were abused children. It can be assumed that all of them had contact
with health providers in their early months and years. It is likely
that had their problems been recognized, opportunities for preventive
interventions were present. Our ongoing failure to recognize risk and
to provide the proven family supports that reduce abuse and later delinquency
could be considered as a failure of the primary health care system because
no other system has both access to almost all families with young children
and the ability to engage them. Home visiting programs have been shown
to reduce child abuse and later delinquency.
Further,
this population of young people is at high risk to prematurely re-enter
the health system. Even if they may have learned to avoid future criminal
acts, the long-term effects of adverse childhood experiences on health
will probably catch up with them in the forms of untreatable obesity,
smoking, drug and alcohol use, heart disease, and certain cancers.
Reading
Mr Hubner's book causes both pain and joy as he mixes history and facts
from the juvenile justice system with the personal stories of the young
people caught in that system. He shows how remarkable (and how hard)
it is for them to take responsibility and to learn empathy. An especially
moving chapter describes how parents of murdered children with extraordinary
courage join with the professional staff to confront youthful murderers
or attempted murderers with the ongoing pain they have caused.
The methods
employed by the staff at the Giddings State School and supported by
the Texas Youth Commission are also of great interest to mental health
professionals and are worthy of study by the many correctional programs
for youth in other states. The "Last Chance" in the title
is apt; the youths who fail to meet the tough criteria for parole from
Giddings will be sent to adult prisons to serve out long sentences.
The specter
of prison did not deter these youths and prison is not enough to turn
them around in four or five years. The Texas program, complex and multifaceted,
appears to offer some success. Some of the main components appear to
be firmly rooted in well-accepted principles of cognitive-behavioral
therapy; other techniques are considered unproven by mainstream psychologists.
It has been difficult to isolate its many components in a way that would
allow rigorous therapeutic research. It's also pretty clear that putting
on a program like this in any state is a tough political task, and that
superimposing an expensive research program that might show why it works
is unlikely.
The Texas
program appears less expensive than the ineffective programs provided
in California and many other states. These more typical programs return
many youths to the street "angrier and dumber" than when they
were confined. The Texas program is very inexpensive in comparison with
prolonged confinement.
Mr Hubner's
book is not a comfortable read, but it is clearly and simply written
with a clear message. It's a good book for all professionals and especially
health professionals.
David L Chadwick, MD, is a pediatrician with
a long history of work in the field of child abuse. Dr Chadwick is also
Director, Emeritus, The Chadwick Center for Children and Families, Children's
Hospital-San Diego and Adjunct Associate Professor, Graduate School of
Public Health, San Diego State University. E-mail: dlchadwick1@earthlink.net.
