Patterns of Diagnosis and Treatment Referral for Justice-Involved Youth

Abstract

There is widespread recognition that adolescents with mental health needs are overrepresented in the juvenile justice system (Robst et al., 2017). In recognition of the limited effectiveness and possible negative effects of incarceration on recidivism, juvenile courts utilize mental health placements, including community-based treatment and residential treatment centers, as an alternative disposition (Mallett & Boitel, 2016). Psychological assessments are often requested by judges to identify emotional, behavioral, environmental, or substance abuse problems that may contribute to offending behavior and to inform recommendations about possible interventions, including mental health treatment (Borum & Otto, 2004). However, there is evidence that the factors that most strongly predict which youth are referred for mental health treatment instead of incarceration include factors that may not be related to diagnosis or need, such as race and gender (Herz, 2001). The goal of the current study is to examine disproportionality in mental health diagnoses and treatment referrals in a sample of adolescents referred by juvenile court judges for psychological evaluations. Analyses using logistic regression indicated that clinical variables such as depression, withdrawal, substance use, and aggression, rather than demographics, most strongly predicted the type of diagnosis a youth received and whether they were referred to residential treatment. Exploration of unadjusted odds ratios indicated that there may still be disproportionality in some outcomes, particularly the diagnosis of externalizing disorders. Implications for clinical practice and research are discussed.