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The relationship between mental health indicators and adjudication rates among youth with serious emotional disturbance

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  • Conduct disorder is often the most prevalent diagnosis reported among justice-involved youth, with estimates ranging from 33-90% (Wierson, Forehand & Frame, 1992; Teplin et al., 2002).
    Other common disorders include: major affective (10-37%), personality (37-50%), and substance abuse (3-50%) disorders (Shelton, 2001; Wierson, Forehand & Frame, 1992; McManus, Alessi, Grapentine & Brickman, 1984; Teplin et al., 2002).
  • Sometimes the
  • I think this was significant, right?

  • So you are going to speak to the clinical implications here right?
    justice histories of youth receiving mental health services in the community must be considered when planning and implementing individualized community-based service Given that the majority of youth convicted of a crime are returned to the community to serve their sentence in the least restrictive setting, mental health services must be available to youth in the community and be flexible enough to respond to the unique challenges of dually involved youth and their families. System-of care service environments provide one such environment for this individualized community-based service provision.
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    • 1. The Relationship between Mental Health Indicators and Adjudication Rates Among Youth with Serious Emotional Disturbance Michele Ybarra, M.P.H.1 Christine Walrath, Ph.D.2 Wayne Holden, Ph.D. 2 Rolando Santiago, Ph.D. 3 Phil Leaf, Ph.D. 1 Johns Hopkins Bloomberg School of Public Health 2 ORC MACRO 3 Child, Adolescent and Family Branch - Center for Mental Health Services 1 International Association of Forensic Mental Health Services Annual Conference, April 2003, Miami FL * Thank you for your interest in this presentation.  Please note that analyses included herein are preliminary. More recent, finalized analyses may be available by contacting CiPHR for further information.
    • 2. Juvenile Justice Involvement and Mental Health  An estimated 2.5 million juvenile arrests were reported in 1999 (Shelton, 2001).  Youth involved with the juvenile justice system have high rates of mental disorder (Shelton, 2001; McManus, Alessi, Grapentine & Brickman, 1984; Wierson, Forehand & Frame, 1992; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002).
    • 3. Youth with Prior Justice Involvement Currently Receiving Services  20% of youth in the public mental health system have a history of juvenile arrest (Rosenblatt, Rosenblatt & Biggs, 2000; Vander Stoep, Evens, & Taub, 1997; Breda, 1995).  Compared to youth receiving mental health services without prior justice involvement, dually-involved youth are: (Rosenblatt, Rosenblatt & Biggs, 2000; Bryant et al., 1994)   more likely to be diagnosed with substance abuse and behavior disorders (e.g., conduct disorder). less likely to be diagnosed with an anxiety disorder.
    • 4. Study Rationale   Similar studies to date have focused on regional samples. The unique characteristics of justice-involved youth provide critical information to the individualized service planning process, therefore  we must investigate mental health challenges faced by dually involved youth and how they differ from other servicereferred youth. This study compares the rate of prior adjudication of service-referred youth as a function of the presence versus absence of specific mental health challenge indicators.
    • 5. Study Methodology  Data were collected by communities funded in 1993 and 1994 (22 sites) as part of the national evaluation of the Comprehensive Community Mental Health Services for Children and Their Families Program.  Sample Selection Criteria: 1) 2) 3) Youth participating in the child and family outcome study of the national evaluation (of a possible 18,906). 10 years of age or older Complete data on 7 study variables. 2,662 who had complete data ⇒ Study Sample Study sample contained slightly more Caucasian youth and youth of ‘other’ races.
    • 6. Measures and Indicators Demographic characteristics Age Gender Race/ethnicity Household income Mental health indicators Global Assessment of Functioning Primary Axis I diagnosis Presenting problem(s) History of delinquency Prior adjudicated misdemeanor Prior adjudicated felony
    • 7. History of Adjudication by Gender (N=2,662) Males with > = 1 prior adjudication 14% Males with no prior adjudication 49% Females with no prior adjuication 31% Females with > = 1 prior adjudication 6%
    • 8. History of Adjudication by Race/Ethnicity N=2,662 Percentage of Youth in Sample 70% 60% 65% No prior adjudciation 58% > =1 prior adjudication 50% 40% 30% 21% 20% 8% 10% 10% 12% 15% 11% 0% White Black Hispanic Race/Ethnicity Other
    • 9. History of Adjudication by Age N=2,662 No prior adjudciation >=1 prior adjudication Percentage of Youth in Sample 30% 25% 24% 20% 15% 18% 13% 14% 14% 10% 12% 14% 15% 14% 10% 5% 0% 15% 19% 4% 5% 5% 2% 10 11 12 13 14 Age (years) 15 16 17
    • 10. Prevalence of Psychiatric Disorder by (N=2,662) Adjudication History Percentage of Youth in Sample adjusted for race/ethnicity, household income, and gender 60% No Adjudications >=1 adjudication 52% 50% 40% 32% 30% 23% 21% 20% 20% 11% 10% 9% 4% 1% 0% r de or is tD uc d on C M o aj D n/ io ss re ep rD ym th ys ia D DH A Primary Axis I Disorder y et xi An t bs Su e nc a d te la Re er rd so Di 4%
    • 11. Analytic Approach  Poisson for count data used to calculate the relative rates of adjudication as a function of multiple indicators of mental health (adjusted for gender, race/ethnicity, household income):    Global Assessment of Functioning (lowest 16% of sample versus higher) Primary Axis I Diagnosis Reason for Referral to Services
    • 12. Analytic Approach (cont.)  Comparisons of youth by adjudication history and primary diagnosis  χ2 tests for differences across the four groups   Prior adjudication w/o CD / SRD  No prior adjudication w/ CD / SRD   Prior adjudication w/ CD / Substance-Related Disorder (SRD) No prior adjudication w/o CD / SRD Comparison of demographic characteristics
    • 13. Relative Rates of Prior Adjudication as a Function of Primary Psychiatric Diagnosis (N=2,662) adjusted for race/ethnicity, household income, and gender 3.5 Relative Rate of Adjudications 3.09 *** 3 2.5 Conduct Disorder Substance Related Disorder Depression/Dysthymia ADHD Anxiety 2.08*** 2 1.5 1.7*** 1.25* 1.23 1 * 0.85 0.5 0 0.62*** 0.65 ** 0.45*** Misdemeanor(s) Felony(s) Adjudication Type ***p<.001; **p<.01; * p<.05 0.21 ***
    • 14. Relative Rates of Prior Adjudication as a Function of Global Functioning (N=2,662) adjusted for race/ethnicity, household income, and gender Relative Rate of Adjudications 1.4 1.34 ** 1.3 1.2 * 1.16 1.1 1 Misdemeanor(s) Felony(s) Adjudication Type **p<.01; * p<.05
    • 15. Relative Rates of Prior Adjudication as a Function of Reason for Referral into Services (N=2,662) adjusted for race/ethnicity, household income, and gender Delinqueuncy-Related Conduct-Related Suicide Hyperactivity Adjustement-Related Depressed Mood Relative Rate of Adjudications 3.5 3.0 3.00 *** 2.5 2.0 1.5 1.76*** 1.22 *** 1.0 0.5 0.0 0.75** 0.67 *** 0.61 *** Misdemeanor(s) 0.76** 0.78 *** 0.51 Adjudication Type Felony(s) ***p<.001; **p<.01; * p<.05 0.73** 0.88 0.93
    • 16. Putting it all Together: Relative Rates of Adjudication Mental Health Indicator Misdemeanor(s) Felony(s) Primary Psychiatric Diagnosis Conduct Disorder > Substance Related Disorder > > Depression/dysthymia < > ADHD < < Anxiety < < Delinquency-Related > > Conduct-Related > < Suicide < Hyperactivity < Adjustment-Related < Depressed Mood < Reason for Referral Global Assessment of Functioning > < >
    • 17. Comparisons of Youth by Adjudication History and Primary Diagnosis (N=2,662) Percentage of Youth in Sample 60% 53% 50% Conduct or Substance-Related Disorder 40% No Conduct or Substance-Related Disorder 27% 30% 20% 10% 11% 9% 0% >=1 None Ajudication History
    • 18. Age as a Function of Four Groups of Adjudication-Primary Diagnosis (N=2,662) 15.0 14.7 14.8 Prior Adjudication w/o CD/SRD Prior Adjudication w CD/SRD Mean Age (years)*** 14.5 No Prior Adjudication w/o CD/SRD No Prior Adjudication w CD/SRD 14.0 13.5 13.0 13.3 13.0 12.5 12.0 Adjudciation-Primary Diagnosis Category *** F=34.8; p<.001
    • 19. Percent of Youth within Adjudication-Primary Diagnosis Category Gender as a Function of Four Groups of Adjudication-Primary Diagnosis (N=2,662) 72% 70% 70% 68% Prior Adjudication w/o CD/SRD Prior Adjudication w CD/SRD 68% No Prior Adjudication w/o CD/SRD No Prior Adjudication w CD/SRD 66% 63% 64% 62% 60% 60% 58% 56% 54% % Male*** ***χ2=16.1; p<.001
    • 20. Percentage of Youth wihtin Adjudication-Primary Diagnosis Category Race/Ethnicity as a Function of Four Groups of Adjudication-Primary (N=2,662) Diagnosis 80% 70% 73% 69% 50% Prior Adjudication w/o CD/SRD 58% 60% Prior Adjudication w CD/SRD 47% No Prior Adjudication w/o CD/SRD No Prior Adjudication w CD/SRD 40% 26% 30% 21% 20% 13% 11%13% 13% 6% 10% 7% 9% 14%12% 8% 0% Non-Hispanic White Hispanic Non-Hispanic Black Race/Ethnicity*** ***χ2=110.8; p<.001 Other
    • 21. Summary Relative rates of adjudication history differ significantly as a function of:  Primary diagnosis  conduct disorder associated with elevated rates of prior adjudication for misdemeanor and felony adjudication  substance abuse and depression/dysthymia associated with elevated rates of felony adjudication  anxiety and ADHD associated with lower rates of prior misdemeanor and felony adjudication  Reason for referral  elevated rates of misdemeanors adjudication associated with referral for delinquency and conduct-related problems  lower rates of misdemeanor adjudication associated with suicide, hyperactivity, adjustment-related, and depressed mood  Global assessment of functioning  elevated rates of misdemeanor and felony adjudications associated with poor (lowest 16% of sample) functioning
    • 22. Summary  44% of youth with a history of conviction had an Axis I diagnosis other than substance abuse or conduct disorder  Youth differ in terms of race/ethnicity, gender, and age as a function of adjudication history-diagnosis category.
    • 23. Study Limitations 1. 2. Cross sectional data Validity of the conviction variable • 1. 2. Caregiver report and administrative record Specific crime types not investigated Collection of psychiatric diagnosis via chart review
    • 24. Implications  Diagnosis at time of intake into service is significantly related to adjudication history among youth with serious emotional disturbance who are referred into system-ofcare services.  Youth with a primary diagnosis other than CDSRD and with a history of adjudication may vary in demographic characteristics compared to other youth.