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

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

1Johns Hopkins Bloomberg School of Public Health2ORC MACRO

3Child, Adolescent and Family Branch - Center for Mental Health Services

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.

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).

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.

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 service-referred 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.

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) Youth participating in the child and family outcome study of

the national evaluation (of a possible 18,906).

2) 10 years of age or older

3) Complete data on 7 study variables.

2,662 who had complete data Study SampleStudy sample contained slightly more Caucasian youth and youth of ‘other’ races.

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

History of Adjudication by Gender(N=2,662)

Females with no prior adjuication

31%

Females with > = 1 prior adjudication

6%Males with no prior adjudication

49%

Males with > = 1 prior adjudication

14%

History of Adjudication by Race/Ethnicity

65%

8%12%

15%

58%

10%

21%

11%

0%

10%

20%

30%

40%

50%

60%

70%

White Black Hispanic Other

Race/Ethnicity

Per

cen

tag

e o

f Y

ou

th i

n S

amp

le

No prior adjudciation

> =1 prior adjudication

N=2,662

History of Adjudication by Age

13% 14% 14%15%

14% 14%

10%

5%

2%4% 5%

12%

18%19%

24%

15%

0%

5%

10%

15%

20%

25%

30%

10 11 12 13 14 15 16 17

Age (years)

Per

cen

tag

e o

f Y

ou

th i

n S

amp

leNo prior adjudciation

>=1 prior adjudication

N=2,662

Prevalence of Psychiatric Disorder by Adjudication History

32%

23% 20%

9%

1%

52%

21%

11%4% 4%

0%

10%

20%

30%

40%

50%

60%

Conduct D

isord

er

Majo

r Depre

ssio

n/Dys

thym

ia

ADHD

Anxiety

Substan

ce R

elat

ed D

isord

er

Primary Axis I Disorder

Per

cen

tag

e o

f Y

ou

th i

n S

amp

le

No Adjudications

>=1 adjudication

adjusted for race/ethnicity, household income, and gender

(N=2,662)

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

Analytic Approach (cont.)

Comparisons of youth by adjudication history and primary diagnosis χ2 tests for differences across the four groups

Prior adjudication w/ CD / Substance-Related Disorder (SRD)

Prior adjudication w/o CD / SRD

No prior adjudication w/ CD / SRD

No prior adjudication w/o CD / SRD

Comparison of demographic characteristics

Relative Rates of Prior Adjudication as a Function of Primary Psychiatric Diagnosis

2.08

1.7

1.23

3.09

0.85

1.25

0.62 0.650.45

0.210

0.5

1

1.5

2

2.5

3

3.5

Adjudication Type

Rel

ativ

e R

ate

of

Ad

jud

icat

ion

s

Conduct Disorder

Substance Related Disorder

Depression/Dysthymia

ADHD

Anxiety

(N=2,662) adjusted for race/ethnicity, household income, and gender

Misdemeanor(s) Felony(s)

***

***

*

**

***

****

***

***

***p<.001; **p<.01; * p<.05

Relative Rates of Prior Adjudication as a Function of Global Functioning

1.16

1.34

1

1.1

1.2

1.3

1.4

Misdemeanor(s) Felony(s)

Adjudication Type

Re

lati

ve

Ra

te o

f A

dju

dic

ati

on

s

(N=2,662)

adjusted for race/ethnicity, household income, and gender

**

*

**p<.01; * p<.05

Relative Rates of Prior Adjudication as a Function of Reason for Referral into Services

3.00

1.76

1.22

0.760.75 0.780.67 0.73

0.61

0.88

0.51

0.93

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Adjudication Type

Re

lati

ve

Ra

te o

f A

dju

dic

ati

on

s

Delinqueuncy-Related

Conduct-Related

Suicide

Hyperactivity

Adjustement-Related

Depressed Mood

(N=2,662)adjusted for race/ethnicity, household income, and gender

**

***

**

***

***

****** ***

**

Misdemeanor(s) Felony(s)

***p<.001; **p<.01; * p<.05

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 < <

Reason for Referral

Delinquency-Related > >

Conduct-Related > <

Suicide <

Hyperactivity < <

Adjustment-Related <

Depressed Mood <

Global Assessment of Functioning > >

Comparisons of Youth by Adjudication History and Primary Diagnosis

9%

53%

11%

27%

0%

10%

20%

30%

40%

50%

60%

> = 1 None

Ajudication History

Pe

rce

nta

ge

of

Yo

uth

in S

am

ple

Conduct or Substance-Related Disorder

No Conduct or Substance-Related Disorder

(N=2,662)

Age as a Function of Four Groups of Adjudication-Primary Diagnosis

14.714.8

13.0

13.3

12.0

12.5

13.0

13.5

14.0

14.5

15.0

Adjudciation-Primary Diagnosis Category

Me

an

Ag

e (

ye

ars

)***

Prior Adjudication w/o CD/SRD

Prior Adjudication w CD/SRD

No Prior Adjudication w/o CD/SRD

No Prior Adjudication w CD/SRD

(N=2,662)

*** F=34.8; p<.001

Gender as a Function of Four Groups of Adjudication-Primary Diagnosis

68%

70%

60%

63%

54%

56%

58%

60%

62%

64%

66%

68%

70%

72%

% Male***

Pe

rce

nt

of

Yo

uth

wit

hin

Ad

jud

ica

tio

n-P

rim

ary

D

iag

no

sis

Ca

teg

ory

Prior Adjudication w/o CD/SRD

Prior Adjudication w CD/SRD

No Prior Adjudication w/o CD/SRD

No Prior Adjudication w CD/SRD

(N=2,662)

***χ2=16.1; p<.001

Race/Ethnicity as a Function of Four Groups of Adjudication-Primary

Diagnosis73%

13%

6% 8%

47%

26%

13% 14%

69%

11%7%

12%

58%

13%9%

21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Non-HispanicWhite

Hispanic Non-HispanicBlack

Other

Race/Ethnicity***

Pe

rce

nta

ge

of

Yo

uth

wih

tin

Ad

jud

ica

tio

n-P

rim

ary

D

iag

no

sis

Ca

teg

ory

Prior Adjudication w/o CD/SRD

Prior Adjudication w CD/SRD

No Prior Adjudication w/o CD/SRD

No Prior Adjudication w CD/SRD

(N=2,662)

***χ2=110.8; p<.001

SummaryRelative 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

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.

Study Limitations

1. Cross sectional data

2. Validity of the conviction variable• Caregiver report and administrative record

3. Specific crime types not investigated

4. Collection of psychiatric diagnosis via chart review

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-of-care services.

Youth with a primary diagnosis other than CD-SRD and with a history of adjudication may vary in demographic characteristics compared to other youth.