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BackgroundMost justice-involved youth are supervised in community settings, where assessment and linkage to substance use (SU) treatment services are inconsistent and fragmented. Only 1/3 of youth with an identified SU need receive a treatment referral and even fewer initiate services. Thus, improving identification and linkage to treatment requires coordination across juvenile justice (JJ) and behavioral health (BH) agencies. The current study examines the comparative effectiveness of two bundled implementation intervention strategies for improving SU treatment initiation, engagement, and continuing care among justice-involved youth supervised in community settings. Exploration, Preparation, Implementation, Sustainment (EPIS) served as the conceptual framework for study design and selection/timing of implementation intervention components, and the BH Services Cascade served as the conceptual and measurement framework for identifying and addressing gaps in service receipt.MethodsPart of a larger Juvenile-Justice Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) Cooperative, this study involved a multisite, cluster-randomized control trial where sites were paired then randomly assigned to receive Core (training teams on the BH Services Cascade and data-driven decision making; supporting goal selection) or Core+Enhanced (external facilitation of implementation teams) intervention components. Youth service records were collected from 20 JJ community supervision agencies (in five states) across five study phases (baseline, pre-randomization, early experiment, late experiment, maintenance). Implementation teams comprised of JJ and BH staff collaboratively identified goals along the BH Cascade and used data-driven decision-making to implement change.ResultsResults suggest that Core intervention components were effective at increasing service receipt over time relative to baseline, but differences between Core and Core+Enhanced conditions were non-significant. Time to service initiation was shorter among Core+Enhanced sites, and deeper Cascade penetration occurred when external facilitation (of implementation teams) was provided. Wide variation existed in the degree and nature of change across service systems.ConclusionsFindings demonstrate the criticality of early EPIS phases, demonstrating that strategies provided during the formative exploration and preparation phases produced some improvement in service receipt, whereas implementation-focused activities produced incremental improvement in moving youth farther along the Cascade.

Juvenile assessment centers (JACs) were developed to address service fragmentation and promote the sharing of information among agencies providing services to youth involved with the juvenile justice system. To date, there are no reports that describe the diagnostic profiles of the youth served by such centers. The authors hypothesize that the rates of psychiatric disorder among youth at JAC intake would be lower than rates reported for youth in secure care, that girls would show higher rates of some disorders, and that those with substance disorders would show higher rates of other, co-occurring disorders. Disorder was measured on the Voice Diagnostic Interview Schedule for Children in 1,012 randomly selected youth (248 girls). Rates of disorder for JAC youth are lower than those reported for incarcerated samples and more comparable to other general intake samples; JAC youth's diagnostic profiles remain elevated compared to youth in the general population, and girls report higher rates of disorder in three of four diagnostic clusters examined. Clinical and policy implications are discussed. (Contains 3 tables.)

Many risks for suicidal behavior, identified in population samples, are elevated in justice youth. We examined whether risks operate similarly in a justice sample. We measured suicidal behavior and disorder on the Diagnostic Interview Schedule for Children in 991 randomly selected youths, and examined associations between demographic, offense, and disorder characteristics and past attempts. Recent attempts were more common in girls, in those with depression or substance disorder, and in violent offenders. While more girls reported recent attempts regardless of depression, depressed boys' attempt risk was as high as girls'. Depression contributed more to attempt history than did substance disorder.

Youth crime is a serious social problem, as is the high proportion of young offenders in the juvenile justice system who have mental disorders. A recent policy innovation applies the theory of therapeutic jurisprudence and diverts youth with mental disorders to treatment in lieu of further court processing. The expansion of mental health diversion programs reflects an increasingly popular view that there is a causal relationship between youth mental disorders and crime. Policymakers who share this view place greater emphasis on rehabilitation and treatment as a way to reduce crime, rather than on stricter punishment. This paper considers the policy issues around youth mental health diversion programs. In addition, it evaluates the effect of a mental health diversion program for youth that was implemented in Texas. The paper finds that mental health diversion can be used effectively to delay or prevent youth recidivism.

EnvironHealthPerspect113(7):894-899 (2005); https://doi.org/10.1289/ehp.7688 The source of the errors in this article, which were limited to the Boston cohort, was twofold. Specifically, performance IQ data were used instead of full-scale IQ [...]

The authors examine the comparability of paper and voice formats of the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) as well as each format's concordance with the Voice Diagnostic Interview Schedule for Children (DISC) among adjudicated youth. Comparability is assessed among 248 youths admitted to a South Carolina Assessment Center. Mean scores and alpha coefficients are calculated, and area under the curve and positive and negative predictive values are used to compare concordance to the DISC. Paper and voice formats are significantly correlated, have similar alpha coefficients, and have comparable concordance with the DISC, suggesting that the MAYSI-2 paper and voice formats are comparable instruments. The voice format may be preferable to the paper format for screening justice youth for mental health problems because it may reduce incomplete data and increase reporting of stigmatized behaviors and because of its ability to automatically generate scored reports and aggregate data.

Despite high rates of substance use, youth involved in the juvenile justice system are unlikely to be linked to the treatment services they need. Family Connect is a flexible, family-focused, linkage intervention developed to address multilevel barriers and increase youth engagement in care through the introduction of a linkage specialist. We describe the components of Family Connect and present findings from the intervention pilot test comparing 18 youth–caregiver dyads to 95 historical controls on referral, attending intake and initiating treatment. Results indicated preliminary support for Family Connect as an approach to increase cross-systems linkage and access to behavioral health care. Findings also suggested support for the feasibility of the intervention and indicated that justice-involved youth and their caregivers found the intervention to be acceptable. In addition to discussing our findings in the context of recent justice reforms, and the importance of improving access to treatment, we make recommendations to inform a future trial of Family Connect. [ABSTRACT FROM AUTHOR]

Objective: To examine the contribution of parent report to youth report in defining psychiatric "caseness" among incarcerated youths. The authors compared reports with each other and examined the influence of varying case definitions. Method: A total of 569 youths in New Jersey, Illinois, and South Carolina admitted into secure placement from 1999 to 2002 were self-administered the Diagnostic Interview Schedule for Children Version 4 (DISC-IV). Parents of assessed youths were asked to complete a parent version of the DISC-IV by telephone. This paper reports on 122 youth-parent dyads. Results: There were four major findings: (1) youths report higher rates of disorder than parents, with rates decreasing when agreement between parents AND youths is required and increasing when parent OR youth report is required; (2) parents and youths showed significant agreement on reports of lifetime suicide attempt; (3) parents were more likely than youths to report that disorders were impairing; and (4) only 30% of parents added substantial new information to the youth report. Conclusions: Parent report potentially adds new information for youths who do not endorse any impairment or deny disorder. However, the value of including parent report for youths in justice and other under-resourced, settings should be balanced with the real challenges involved in obtaining information from parents.

Objective: To examine associations between the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) and Diagnostic Interview Schedule for Children-Present State Voice Version (DISC-IV) and the extent to which they overlap in identifying youths with mental health concerns. Method: Among 325 New Jersey and South Carolina correctional youths, associations were examined using receiver operating characteristic analyses and logistic regression (binomial and multinomial). Results: MAYSI-2 subscales generally mapped best onto homotypic DISC-IV disorders; however, many subscales mapped almost as well onto heterotypic disorders. Alcohol/Drug Use and Suicide Ideation, respectively, identified youths reporting substance disorder and recent attempt; other subscales did not identify parallel DISC-IV disorders as well. Conclusions: MAYSI-2 identifies some DISC-IV disorders better than others. Lack of overlap may result from MAYSI-2's combining diagnostic constructs into single subscales. Substantial percentages of disordered youths were not identified by corresponding subscales. In systems with multiple avenues of referral, the MAYSI-2 is a useful intake screen, but its utility as the sole means for identifying diagnoses for treatment purposes is limited. The authors differentiate between screening for emergent risk and service needs, recommending best practices for a comprehensive approach to mental health assessment among justice youth.

We investigated the independent contributions of maternal history of antisocial behavior and parenting practices to the worsening course of sons' behavior problems in a sample of young urban boys at risk for antisocial behavior. Mothers reported on boys' behavior problems at baseline and one year later, as well as on their own history of antisocial behavior before and after age 15, and of lifetime depression and substance use disorders (provisional DSM-III-R diagnoses). Baseline reports of parenting practices were obtained. Lower involvement, lower monitoring, and higher levels of parent-child conflict and maternal Conduct Disorder (CD) before age 15 contributed to the worsening of boys' behavior problems one year later; mothers' symptoms of Antisocial Personality Disorder after age 15 did not. Mothers' lifetime history of Major Depression and Substance Use Disorder did not add to the worsening of boys' behavior problems after accounting for these other factors. Although maternal CD contributed directly to the worsening of boys' behavior problems, the effect of parenting was more substantial. We discuss clinical implications for prevention and treatment of children's antisocial behavior, and intergenerational implications of girls' early antisocial behavior.

Purposes of this study were to identify certain psychosocial attributes and life experiences of minority adolescent mothers and explore variations in these attributes and experiences in and across age and ethnic groups. (PCB)