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OBJECTIVE--To determine the efficacy of psychiatric liaison schemes to magistrates' courts in shortening the period that mentally ill accused people spend in custody between arrest, the provision of psychiatric reports, and admission to hospital under the Mental Health Act 1983 and to establish the direct costs of setting up such schemes. DESIGN--A nine month prospective study of court referrals and concurrent analysis of prison records. SETTING--An inner London magistrates' court (Clerkenwell) and a large remand prison (Brixton). PATIENTS--Consecutive series of 80 remand prisoners receiving psychiatric assessment through a liaison scheme; 50 remand prisoners placed on hospital orders by magistrates' courts after being remanded to prison for reports; 364 psychiatric prisoners undergoing second opinion assessments at a remand prison; 520 offenders in a remand prison placed on hospital orders. MAIN OUTCOME MEASURES--Comparison of lengths of time spent in custody for different stages of the assessment and disposal process. RESULTS--For the 50 remand prisoners assessed in prison the mean time from arrest to appearance in court with a psychiatric report was 33.7 days and from arrest to admission to hospital 50.8 days. For those examined in court under the liaison scheme the equivalent figures were 5.4 days (t = 12.63, p less than 0.0001) and 8.7 days (t = 13.04, p less than 0.0001). The number of hospital orders made at the court increased fourfold after the liaison scheme began. The additional direct costs of the scheme were negligible. CONCLUSION--Psychiatric liaison services to magistrates' courts can greatly reduce the length of time that offenders with mental disorders spend in custody. Such schemes may increase recognition of offenders suitable for admission to hospital. A scheme could be established in some areas within existing service provision.

Objective

To compare the prevalence of psychiatric disorders in youths processed in adult criminal court with youths processed in the juvenile court.

Methods

Participants were a stratified random sample of 1829 youths (10–18 years of age) arrested and detained in Chicago, IL. Data on 1715 youths (13–18 years of age) from version 2.3 of the Diagnostic Interview Schedule for Children are presented, including 1440 youths processed in juvenile court and 275 youths processed in adult criminal court.

Results

Among youths processed in the adult criminal court, 66% had at least one psychiatric disorder and 43% had two or more types of disorders. Prevalence rates and the number of comorbid types of disorders were not significantly different between youths processed in adult criminal court and those processed in the juvenile court. Among youths processed in adult criminal court, those sentenced to prison had significantly greater odds of having disruptive behavior, substance use, or comorbid affective and anxiety disorders than those receiving a less severe sentence. Males, African Americans, Hispanics, and older youths had greater odds of being processed in adult criminal court than females, non-Hispanic whites, and younger youths, even after controlling for felony-level violent crime.

Conclusions

Community and correctional systems must be prepared to provide psychiatric services to youths transferred to adult criminal court, and especially to youths sentenced to prison. Psychiatric service providers must also consider the disproportionate representation of racial/ethnic minorities in the transfer process when developing and implementing services.

Editor’s note:

Juvenile court judges are asked to determine what is in the best interest of the child in every case they hear. As Judge Cindy S. Lederman writes, making these decisions without an awareness of the science of child development can be detrimental to the mental and physical well-being of the child. Yet until about a decade ago, court decisions were routinely made without taking into consideration the needs of toddlers and infants. The Miami Child Well-Being Court™ (MCWBC) program, a partnership of clinicians and judges, has brought science into the courtroom, making it integral to the decision-making process and working to ensure that the needs of the child are met.

The recent increase in the number of girls involved in the juvenile justice system has resulted in increased academic and public attention. Thus far, this attention has focused on entry into the juvenile justice system rather than longer-term consequences. This research helps fill this gap by examining a sample of 700 maltreated and/or impoverished juvenile court–involved females. Competing risks models were used to control for time from juvenile-court entry to adult outcomes: criminal justice system involvement, use of public mental health or substance use services, and income maintenance use. Results indicate that there are distinct predictors associated with the different outcomes, although learning disability and adolescent parenthood were associated with higher risk of both mental health/substance use services and income maintenance. Individualized services for juvenile court–involved girls are suggested. Prospective, longitudinal research is needed to investigate intrapsychic and behavioral dynamics associated with females’ young adult outcomes.

Historically, the juvenile court has been expected to consider each youth's distinct rehabilitative needs in the dispositional decision-making process, rather than focusing on legal factors alone. This study examines the extent to which demographic, psychological, contextual, and legal factors, independently predict dispositional outcomes (i.e., probation vs. confinement) within two juvenile court jurisdictions (Philadelphia, Phoenix). The sample consists of 1,355 14- to 18-year-old male and female juvenile offenders adjudicated of a serious criminal offense. Results suggest that legal factors have the strongest influence on disposition in both jurisdictions. For example, a higher number of prior court referrals is associated with an increased likelihood of secure confinement in both jurisdictions. Juveniles adjudicated of violent offenses are more likely to receive secure confinement in Phoenix, but are more likely to be placed on probation in Philadelphia. Race is unrelated to dispositional outcome, but, males are consistently more likely than females to be placed in secure confinement. Importantly, individual factors (e.g., developmental maturity) generally were not powerful independent predictors of disposition. Finally, an examination of the predictors of juvenile versus adult court transfer in Phoenix indicated that males, older juveniles, and those with a violent adjudicated charge were more likely to be transferred to adult court, while juveniles scoring high on responsibility as well as those juveniles with an alcohol dependence diagnosis were more likely to be retained in juvenile court.

Juvenile drug courts (JDC) largely focus on marijuana and other drug use interventions. Yet, JDC offenders engage in other high-risk behaviors, such as alcohol use and sexual risk behaviors, which can compromise their health, safety and drug court success. An examination of alcohol use and sexual risk behaviors among 52 male substance abusing young offenders found that over 50% were using alcohol, 37% reported current marijuana use and one-third of all sexual intercourse episodes were unprotected. After accounting for recent marijuana use, the odds of a juvenile having vaginal or anal sex was 6 times greater if they had recently used alcohol. Juvenile drug courts may benefit from delivering alcohol and sexual risk reduction interventions to fully address the needs of these young offenders.

The juvenile justice system faces a difficult challenge when providing services to serious adolescent offenders, having to balance community safety concerns with hopes for successful intervention. Increasing the effectiveness of this system rests partially on having a clearer picture of the regularities of current service provision to these adolescents. This study describes the types of services received by a large (N=868) sample of adjudicated serious offenders from two metropolitan areas over a two-year follow-up period after adjudication in court, and examines whether indicators of need for services determine the types of services received in the juvenile justice system. Findings indicate that: 1) the level of specialized services received is rather low, 2) there is considerable site variability, 3) the service needs of adolescents sent to different types of settings appear to be generally equivalent, 4) state training schools appear to provide about the same level of services found in contracted provider settings, and 5) need is an inconsistent determinant of service provision.

Many youth in juvenile justice are in need of substance use services, yet referral to services is often inadequate. This study examines the ecological factors related to substance use service referrals made through Tennessee’s juvenile courts. A series of hierarchical binomial logistic models indicated that individual-level factors accounted for 31% of the variance among courts in referral rates. Community and court factors accounted for an additional 16% of the variance. Youth were more likely to be referred if they had a higher need, were White, were male, were adjudicated in communities that had a higher service density, and appeared in courts that had good relationship and frequent contact with mental health providers. Controlling for individual need, youth in rural areas tended to have lower referral rates; however, this relationship was mediated by the frequency of contact and the quality of relations between the court and mental health providers and county average SES.

Prior research indicates that adolescent offenders transferred to adult court are more likely to recidivate than those retained in the juvenile system. The studies supporting this conclusion, however, are limited in addressing the issue of heterogeneity among transferred adolescents. This study estimates the effect of transfer on later crime using a sample of 654 serious juvenile offenders, 29% of whom were transferred. We use propensity score matching to reduce potential selection bias, and we partition the sample on legal characteristics to examine subgroup effects. We find an overall null effect of transfer on re-arrest, but evidence of differential effects of transfer for adolescents with different offending histories. These results suggest that evaluating the effects of transfer for all transferred adolescents together may lead to misguided policy conclusions.

Using data from a recent randomized clinical trial involving juvenile drug court (JDC), youth marijuana use trajectories and the predictors of treatment non-response were examined. Participants were 118 juvenile offenders meeting diagnostic criteria for substance use disorders assigned to JDC and their families. Urine drug screen results were gathered from weekly court visits for 6 months, and youth reported their marijuana use over 12 months. Semiparametric mixture modeling jointly estimated and classified trajectories of both marijuana use indices. Youth were classified into responder versus non-responder trajectory groups based on both outcomes. Regression analyses examined pretreatment individual, family, and extrafamilial predictors of non-response. Results indicated that youth whose caregivers reported illegal drug use pretreatment were almost 10 times as likely to be classified into the non-responder trajectory group. No other variable significantly distinguished drug use trajectory groups. Findings have implications for the design of interventions to improve JDC outcomes.

Background

The purpose of the current study was to evaluate the impact of a July 2008 Tennessee Court of Appeals opinion that shifted financial responsibility for juvenile court ordered psychiatric evaluations from the State to the County.

Methods

We used de-identified administrative data from the Tennessee Department of Mental Health and mid-year population estimates from the U.S. Census Bureau from July 1, 2006 to June 30, 2010, and an interrupted time series design with segmented regression analysis to quantify the impact of the implementation of the Court opinion.

Results

In the study period, there were 2,176 referrals for juvenile court ordered psychiatric evaluations in Tennessee; of these, 74.1% were inpatient evaluations. The Court opinion was associated with a decrease of 9.4 (95% C.I. = 7.9–10.8) inpatient and increase of 1.2 (95% C.I. = 0.4–2.1) outpatient evaluations per 100,000 Tennessee youth aged 12 to 19 years per month.

Conclusions

The Court opinion that shifted financial responsibility for juvenile court ordered psychiatric evaluations from the State to the County was associated with a sudden and significant decrease in inpatient psychiatric evaluations, and more modest increase in outpatient evaluations.

Background

Juvenile drug court offenders have benefited from evidence-based interventions addressing antisocial behavior, mental health and/or substance use; however, interventions addressing HIV risk behavior are lacking. This study presents pilot findings and lessons learned from a group-based HIV prevention intervention delivered to juvenile drug court offenders.

Methods

Participants were randomized to a 5-session HIV Prevention (n =29) or Health Promotion (n=28) condition and completed measures of sexual risk taking and substance use at baseline and 3 month post-intervention.

Results

No between-group differences by time emerged on measures of sexual risk-taking or other HIV-related behaviors and attitudes. Both groups improved their rates of HIV testing and decreased their substance use during sex over time.

Conclusions

Delivering an HIV prevention intervention to drug court offenders is feasible; however, more intensive interventions that incorporate multiple systems and address co-occurring mental health difficulties may be needed to affect sexual behavioral change among these high-risk court-involved youth.

The 12-month cost effectiveness of juvenile drug court and evidence-based treatments within Court were compared with traditional Family Court for 128 substance abusing/dependent juvenile offenders participating in a four-condition randomized trial. Intervention conditions included Family Court with community services (FC), Drug Court with community services (DC), Drug Court with Multisystemic Therapy (DC/MST), and Drug Court with MST enhanced with a contingency management program (DC/MST/CM). Average cost effectiveness ratios for substance use and criminal behavior outcomes revealed that economic efficiency in achieving outcomes generally improved from FC to DC, with the addition of evidence-based treatments improving efficiency in obtaining substance use outcomes.