T-Man's life turned upside down on May 11, 2024.
The day before had felt like a nearly perfect Friday afternoon. The 16-year-old, who is being identified by his nickname because he's a minor, had wandered around the park on Chicago’s West side with his cousin, also 16, after school. They talked to girls. T-Man said he and his cousin stayed up until 3 a.m. talking.
When T-Man woke up Saturday, his cousin had stopped breathing. T-Man and his uncle rushed his cousin to the hospital, where doctors ruled the teenager had died from an overdose. T-Man said he had no idea his cousin had used any drugs.
“This was a person I never thought I’d be closing the casket on,” T-Man said in a recent interview. “I never experienced that type of pain before.”
T-Man and his cousin had leaned on each other to deal with the high rates of overdose deaths and gun violence in their neighborhood. On most days, the pair would ask, “What do I need to do today to stay safe?” T-Man said.
Two months before his cousin's overdose, T-Man had joined Choose to Change, a program that pairs cognitive behavioral therapy (CBT) with intensive mentoring to help kids cope with the violence they witness. The program is part of a growing trend of CBT-based violence prevention efforts around the country.
Research shows that youth who are exposed to high levels of trauma are more likely to struggle with depression, addiction and suicide.). They’re also more likely to perpetrate violence and end up incarcerated.
But evidence has mounted over the last decade that the growing number of CBT programs like Choose to Change can help some kids break this cycle.
CBT is a kind of talk therapy that focuses less on past traumas and more on present behavior. At its most simple, the idea is to help people change patterns of thought and behavior, in order to develop more effective ways to cope with life.
Dozens of studies dating back to the 1970s — mostly of adults who were incarcerated — show that CBT has reduced the likelihood that someone released from jail or prison returns. More recently, a string of rigorous evaluations have found that CBT-based programs designed for teens and young adults in the community can significantly reduce the chance that they will be arrested for a violent crime. A University of Chicago study found that participants in Choose to Change were significantly less likely to be arrested compared to similar teens who were not in the program.
But as promising as that evidence may be, many of these initiatives have struggled to connect with young people, particularly students who are often absent from school.
“Figuring out how to get people to voluntarily engage with that kind of treatment is in some ways the million-dollar question,” said Jennifer Doleac, who studies criminal justice at the philanthropic think tank Arnold Ventures. (Arnold Ventures is a financial supporter of Tradeoffs and The Marshall Project.)
The Choose to Change program, which launched in Chicago a decade ago, was designed for kids who are hard to engage. Today, the program goes into the city's public high schools and works with teenagers who miss lots of class, are at high risk of committing violence, and who may be skeptical of going to therapy.
Teens attend up to 16 weeks of group CBT sessions and are matched with an adult mentor, called an advocate, who spends at least 8 hours a week with the young person. The advocates do everything from taking the young people out to sporting events and meals to helping them find jobs or open a bank account.
At the program’s inception, the idea was that the advocate — a caring, capable adult with cultural credibility — would support the entire family and build buy-in, said Gary Ivory, the CEO and President of Youth Advocate Programs, or YAP.
“We helped make sure [the kids] showed up [to therapy],” Ivory said. “And then those learnings from those group sessions, we help them to apply it in their home and community settings.”
T-Man, a top student, started Choose to Change several months before his cousin died. A school dean hoped the program would help the young man, who had a history of getting into fights.
“I just couldn't keep a small problem small,” said T-Man.
Managing anger is a common challenge for youth who are repeatedly exposed to trauma, according to Julia Noobler, director of mental health at Brightpoint, the nonprofit that co-founded Choose to Change and staffs the program with therapists.
“Your thinking brain [can go] offline because your brain's trying to keep you as safe as possible,” Noobler said.
This can be helpful in moments of danger, said Noobler, but it can also lead kids to respond to minor situations as major threats. A disagreement with a teacher turns into a shouting match; a bump in the hall turns into a fight; an argument turns into a shooting.
“What we're trying to do,” explained Noobler, “is slow that train down and engage the young person in evaluating what's happening and stay in their thinking brain.”
The death of T-Man's cousin had left an enormous hole, and the teen was reeling. “I was just in a dark space,” T-Man said of that time. “I was feeling like no one could help me. I was really just angry at myself and the world.”
Despite his participation in Choose to Change, police arrested T-Man after a physical altercation in early June 2024. He spent the next 31 days in juvenile detention.
T-Man watched other kids detained there struggle to manage their emotions. He said he surprised himself as his mind drifted back to the lessons he’d picked up in Choose to Change.
One session involved shaking up and opening bottles of Sprite. T-Man remembered watching one explode everywhere — like he did when he got mad. A different bottle, shaken just as hard, fizzed normally as students released the pressure slowly. Sitting alone in detention, T-Man wondered what would happen if he let his anger and hurt out little by little — something he’d always been afraid to do.
“Maybe I do need to work on expressing myself and talking about how I feel more,” T-Man recalled thinking.
He asked to see a therapist and started making goals for after he got out: get his class ranking back to number two, land a job, and most importantly, think before he acts. T-Man spent a lot of time after his release that summer talking through his goals with his advocate Theresa Wright.
“We talked about things to prevent history repeating itself,” Wright said. “When we started setting those goals, he became excited.”
Choose to Change aims to help teens see distortions in their own thinking, better understand the motivation of others, and gain confidence in their ability to solve problems.
When T-Man returned to school in August 2024 as a junior, he quickly had opportunities to apply these new skills. When he got upset that a teacher had posted a grade late, he kept his cool and tracked down one of the school’s deans, who suggested T-Man ask the teacher after class when she would post grades.
“It was like I took a big step forward into working on myself and working on my anger and how I deal with things,” T-Man said. “So I was definitely proud of myself.”
The experts’ optimism around CBT-based programs stems from the studies that show their ability to significantly reduce arrests among high-risk teens — evidence that many violence prevention programs lack.
Between 2015 and 2019, researchers at the University of Chicago Crime Lab followed 1,000 Chicago teens who were offered Choose to Change and compared their outcomes to 1,000 similar kids who only had access to more traditional services, like in-school counseling and after-school programs.
Researchers found that youth in Choose to Change were 31% less likely to be arrested in the two years after they started the program, and 39% less likely to be arrested for a violent crime.
“We were very surprised to see the results of the program,” said Nour Abdul-Razzak, who co-led the randomized control trial. “The numbers are quite large in terms of how it's helping young people, and they are working with a higher risk population.”
Abdul-Razzak says this research adds further evidence that cognitive behavioral therapy helps high-risk kids. It also demonstrates that CBT and intensive mentorship works for young people who other programs failed to reach. Of the 2,000 teens in the study, 35% had a prior arrest, and 70% had missed at least three weeks of school.
Perhaps the study's most surprising finding is that the reduction in violent arrests lasted long after the students entered the program — up to four years.
What’s driving those results is unclear, says Abdul-Razaak, but her hunch is that pairing CBT with intensive wrap-around support is a potent one-two combo.
“Because the mentors are attending the group CBT sessions, they're learning those same tools and skills,” she said, “and so they can practice them with the kids outside in the community.”
Charles Branas, an epidemiologist and gun violence expert at Columbia University, who was not involved in the study, says the finding is promising.
“The long term effect of this program and the fact that this is a randomized controlled trial of a substantial number of people leads me to believe that it could indeed be a very big deal,” Branas said, though he cautioned that the study must go through peer review before he can fully endorse the findings.
Doleac at Arnold Ventures says this paper moves us closer to answering her question about how to voluntarily engage high-risk teens with CBT.
“In a context where most of our good ideas don't work,” she said, “it's extremely exciting to see evidence that this is the kind of intervention that pretty dramatically can transform young people's lives.”
Youth Advocate Programs, the group that provides the Choose to Change advocates, has launched similar programs in Tennessee, California, Iowa, Texas, and New Jersey — where Ivory, the YAP CEO, says they’ve begun working with Rutgers University to study that state’s program.
Early results are promising, Ivory said, but keeping the programs funded is hard. Choose to Change costs about $8,500 per student annually; it cost $11 million this year to run the program for 1,300 kids in Chicago. Philanthropy, the mayor's office and Chicago Public Schools financially support the program.
But the school system is facing a $500 million budget shortfall. Toni Copeland, the district’s director of student supports and violence prevention, says Choose to Change has stopped accepting new teens while they try to find new money for next year.
“We've tried to be innovative in finding solutions to make up for whatever the gap is, because the district believes in Choose to Change,” Copeland said.
Despite the program's price tag, researchers have estimated that Choose to Change saves taxpayers up to $20,000 per youth, due to less involvement with police, public defenders, courts and the juvenile detention system over time.
It's difficult to pinpoint why young people are less likely to get arrested, even years after they leave Choose to Change — something other CBT programs have failed to accomplish. One theory is that the youth-advocate bond helps teens successfully incorporate the lessons of CBT into their daily lives.
Nearly a year after T-Man finished the program, he is still in constant contact with his advocate.
“I know I could talk to Miss Theresa about anything, and she won't judge me,” said T-Man. “She'll be there for me and try to help the situation before anything.”
“He calls me about everything,” Wright said with a laugh. “‘Miss Theresa, I’ve got my own job. I'm giving back.’ Every milestone that's happening in his life, he always calls.”
T-Man said their connection has helped him check off his goals. He landed a job as a counselor for young kids. He's managed his anger and avoided trouble since his arrest. And he's number three in his class — one spot from his goal.
“She’s seen something that I didn't see in myself at first,” said T-Man. “It helped me realize the strengths that I had, the talent I had, like how far I could go with it.”
This story was originally produced by Tradeoffs, a nonprofit newsroom reporting on health care’s toughest choices. Sign up for their weekly newsletter to get their latest stories every Thursday morning. Tradeoffs reporting for this story was supported, in part, by the Sozosei Foundation.
