Early development of local data dashboards to depict the substance use care cascade for youth involved in the legal system: qualitative findings from end users.

INTRODUCTION: Rates of substance use are high among youth involved in the legal system (YILS); however, YILS are less likely to initiate and complete substance use treatment compared to their non legally-involved peers. There are multiple steps involved in connecting youth to needed services, from screening and referral within the juvenile legal system to treatment initiation and completion within the behavioral health system. Understanding potential gaps in the care continuum requires data and decision-making from these two systems. The current study reports on the development of data dashboards that integrate these systems' data to help guide decisions to improve substance use screening and treatment for YILS, focusing on end-user feedback regarding dashboard utility. METHODS: Three focus groups were conducted with n = 21 end-users from juvenile legal systems and community mental health centers in front-line positions and in decision-making roles across 8 counties to gather feedback on an early version of the data dashboards; dashboards were then modified based on feedback. RESULTS: Qualitative analysis revealed topics related to (1) important aesthetic features of the dashboard, (2) user features such as filtering options and benchmarking to compare local data with other counties, and (3) the centrality of consistent terminology for data dashboard elements. Results also revealed the use of dashboards to facilitate collaboration between legal and behavioral health systems. CONCLUSIONS: Feedback from end-users highlight important design elements and dashboard utility as well as the challenges of working with cross-system and cross-jurisdiction data.

"Weeding out" violence? Translational perspectives on the neuropsychobiological links between cannabis and aggression.

Recent shifts in societal attitudes towards cannabis have led to a dramatic increase in consumption rates in many Western countries, particularly among young people. This trend has shed light on a significant link between cannabis use disorder (CUD) and pathological reactive aggression, a condition involving disproportionate aggressive and violent reactions to minor provocations. The discourse on the connection between cannabis use and aggression is frequently enmeshed in political and legal discussions, leading to a polarized understanding of the causative relationship between cannabis use and aggression. However, integrative analyses from both human and animal research indicate a complex, bidirectional interplay between cannabis misuse and pathological aggression. On the one hand, emerging research reveals a shared genetic and environmental predisposition for both cannabis use and aggression, suggesting a common underlying biological mechanism. On the other hand, there is evidence that cannabis consumption can lead to violent behaviors while also being used as a self-medication strategy to mitigate the negative emotions associated with pathological reactive aggression. This suggests that the coexistence of pathological aggression and CUD may result from overlapping vulnerabilities, potentially creating a self-perpetuating cycle where each condition exacerbates the other, escalating into externalizing and violent behaviors. This article aims to synthesize existing research on the intricate connections between these issues and propose a theoretical model to explain the neurobiological mechanisms underpinning this complex relationship.

Non-suicidal Self-Injury, Suicidal Behaviors, and Mental Health Symptoms among Sexual Minority Youth with Juvenile Justice System Involvement.

Sexual minority youth have long remained an understudied population within the juvenile justice system, despite emerging evidence suggesting that sexual minority youth are overrepresented. Recent literature indicates that system-involved sexual minority youth may have more behavioral health concerns than their heterosexual counterparts. Even so, more work is needed to elucidate the unique needs of sexual minority youth who become involved in the system, especially as it pertains to suicidal behaviors and non-suicidal self-injury (NSSI). The present study provided a descriptive evaluation of the prevalence of sexual minority youth making early system contact and their mental health concerns. Of the 218 justice-involved youth from a Northeastern family court in the sample, over a quarter identified as a sexual minority (n = 58). Our findings indicated that these youth evidenced significantly higher scores on a mental health screener compared to their heterosexual counterparts, evidencing greater symptomology on scales indicative of depression/anxiety, thought disturbance, etc. Further, sexual minority youth reported higher rates of lifetime, past year, and past month NSSI as well as lifetime and past year suicide attempts. These findings highlight the need to support the well-being of sexual minority youth in the juvenile justice system by screening for and addressing their mental health needs in this unique setting.

Creating profiles of juvenile offenders using functions of aggression and callous-unemotional traits: relations to crime type.

A rich line of criminological theories and research has suggested that individual characteristics may be important to predicting criminal activity. However, there is limited research examining how individual characteristics may be related to the type of crime committed (e.g. violent, sex, drug). To provide guidance to these questions, the current set of two studies used latent profile analysis to identify groups of offenders based on individual factors (i.e. proactive and reactive aggression, and callous-unemotional traits), chosen for their interrelatedness and their established associations with crime, and examined whether these groups relate to type, severity or the number of crimes committed across two studies. In both studies, four groups of offenders were identified, but these groups were not associated with offending behaviors or patterns. Findings and implications are discussed.

Use of Project ECHO to promote evidence based care for justice involved adults with opioid use disorder.

Background: People with opioid use disorders (OUDs) are at heightened risk for involvement with the criminal justice system. Growing evidence supports the safety and effectiveness of providing empirically supported treatments for OUD, such as medications for OUD (M-OUD), to people with criminal justice involvement including during incarceration or upon reentry into the community. However, several barriers limit availability and accessibility of these treatment options for people with OUDs, including a shortage of healthcare and justice professionals trained in how to implement them. This study evaluated a novel education program, the Indiana Jail OUD Treatment ECHO, designed to disseminate specialty knowledge and improve attitudes about providing M-OUD in justice settings. Methods: Through didactic presentations and case-based learning (10 bimonthly, 90-min sessions), a multidisciplinary panel of specialists interacted with a diverse group of community-based participants from healthcare, criminal justice, law enforcement, and related fields. Participants completed standardized surveys about OUD knowledge and attitudes about delivering M-OUD in correctional settings. Thematic analysis of case presentations was conducted. Results: Among 43 participants with pre- and post-series evaluation data, knowledge about OUD increased and treatment was viewed as more practical after the ECHO series compared to before. Cases presented during the program typically involved complicated medical and psychiatric comorbidities, and recommendations addressed several themes including harm reduction, post-release supports, and integration of M-OUD and non-pharmacological interventions. Conclusions: Evaluation of future iterations of this innovative program should address attendance and provider behavior change as well as patient and community outcomes associated with ECHO participation.

Feasibility and acceptability of a brief suicide intervention for youth involved with the family court.

As efforts to develop models for suicide prevention and intervention in the juvenile justice (JJ) system continue to grow, research to understand the feasibility and acceptability of implementing these models is critical. Examining organizational readiness for implementation, ensuring leadership and staff buy-in for delivering the intervention, and planning for sustainability of staff participation in implementation efforts is essential. The current study involved semi-structured formative evaluation interviews with key JJ stakeholders (n = 10) to determine perspectives on the acceptability (perceived need and fit of the intervention) and feasibility (organizational readiness for change) of a proposed brief safety planning intervention for youth with suicidal ideation delivered by nonclinical staff and integrated into the existing system. Qualitative data revealed stakeholders' perceived need for the intervention in the family court context and their agreement that the aims of the intervention were congruent with the goals of the family court. Some barriers to successful implementation were noted, which, addressed through selection of appropriate implementation strategies, can be overcome in a future test of the safety intervention.

Examining ODD/ADHD Symptom Dimensions as Predictors of Social, Emotional, and Academic Trajectories in Middle Childhood.

The goal of this article is to investigate the symptom dimensions of oppositional defiant disorder (ODD; irritability, defiance) and attention deficit/hyperactivity disorder (ADHD; inattention, hyperactivity-impulsivity) as predictors of academic performance, depressive symptoms, and peer functioning in middle childhood. Children (N = 346; 51% female) were assessed via teacher-report on measures of ODD/ADHD symptoms at baseline (Grades K-2) and academic performance, depressive symptoms, peer rejection, and victimization on 7 occasions over 4 school years (K-2 through 3-5). Self-report and grade point average data collected in Grades 3-5 served as converging outcome measures. Latent growth curve and multiple regression models were estimated using a hierarchical/sensitivity approach to assess robustness and specificity of effects. Irritability predicted higher baseline depressive symptoms, peer rejection, and victimization, whereas defiance predicted higher baseline peer rejection; however, none of these ODD-related effects persisted 3 years later to Grades 3-5. In contrast, inattention predicted persistently poorer academic performance, persistently higher depressive symptoms, and higher baseline victimization; hyperactivity-impulsivity predicted subsequent peer rejection and victimization in Grades 3-5. In converging models, only inattention emerged as a robust predictor of 3-year outcomes (viz., grade point average, depressive symptoms, peer rejection, and relational victimization). Broadly, ODD dimensions-particularly irritability-may be linked to acute disturbances in social-emotional functioning in school-age children, whereas ADHD dimensions may predict more persistent patterns of peer, affective, and academic problems. By examining all 4 ODD/ADHD symptom dimensions simultaneously, the present analyses offer clarity and specificity regarding which dimensions affect what outcomes, and when. Findings underscore the importance of multidimensional approaches to research, assessment, and intervention.

The Role of Parenting Styles in the Relation Between Functions of Aggression and Internalizing Symptoms in a Child Psychiatric Inpatient Population.

Psychiatric inpatient hospitalization is a costly intervention for youth. With rates of hospitalization rising, efforts to refine prevention and intervention are necessary. Aggression often precedes severe internalizing behaviors, and proactive and reactive functions of aggression are differentially associated with internalizing symptomatology. Thus, further understanding of the links between functions of aggression and internalizing symptomatology could aid in the improvement of interventions for hospitalized youth. The current study examined parenting styles, gender, and age as potential moderators of the relations between proactive and reactive aggression and internalizing symptoms. Participants included 392 children, 6-12 years of age admitted consecutively to a psychiatric inpatient unit. Reactive aggression was uniquely associated with anxiety symptoms. However, proactive aggression was associated with internalizing problems only when specific parenting styles and demographic factors were present. Although both proactive and reactive subtypes of aggression were associated with internalizing symptoms, differential associations were evident. Implications of findings are discussed.

Associations Between Physical and Relational Forms of Peer Aggression and Victimization and Risk for Substance Use Among Elementary School-Age Youth.

This study examined associations between physical and relational forms of aggression and victimization and risk for willingness to engage in substance use and actual use in a sample of 231 (50% Male) 2nd thru 4th grade students (Mean age = 8.3 years). Physical aggression was more strongly associated with risk for substance use outcomes than physical victimization. Neither relational aggression nor victimization were linked to risk for substance use. Specifically targeting physical aggression for the prevention of early substance use among elementary school-age youth appears to be warranted.

The impact of parenting on the associations between child aggression subtypes and oppositional defiant disorder symptoms.

The current study evaluated parenting behaviors (i.e., parental monitoring, inconsistent discipline, parental involvement, positive parenting, and corporal punishment) as moderators of the link between proactive and reactive aggression and oppositional defiant disorder (ODD) symptoms in a community sample of 89 children ranging from 9 to 12 years of age (M = 10.44, SD = 1.14; 56 % male). Reactive, but not proactive, aggression was uniquely positively associated with ODD symptoms. Additionally, inconsistent discipline moderated the association between proactive, but not reactive, aggression and ODD symptoms, such that proactive aggression was associated with ODD symptoms only when levels of inconsistent discipline were high. Findings appear to suggest that associations between these aggression subtypes and ODD symptoms are influenced by different factors, with inconsistent discipline indicated in the association between proactively aggressive behavior and ODD symptoms. Implications for intervention are discussed.

A classification system for youth outpatient behavioral health services billed to medicaid.

Rates of youth behavioral health concerns have been steadily rising. Administrative data can be used to study behavioral health service utilization among youth, but current methods that rely on identifying an associated behavioral health diagnosis or provider specialty are limited. We reviewed all procedure codes billed to Medicaid for youth in one U.S. county over a 10-year period. We identified 158 outpatient behavioral health procedure codes and classified them according to service type. This classification system can be used by health services researchers to better characterize youth behavioral health service utilization.

Data Collection Among Sexual and Gender Minority Youth Involved in the Legal System.

Sexual and gender minority (SGM) youth are at disproportionately higher rates of being involved in the youth legal system compared to their heterosexual and cisgender peers.1-3 Research highlights that mental health symptoms and suicidal ideation and behavior are more common among SGM legally involved youth (LIY) compared to LIY who are not SGM,4 which calls upon the urgent need to build research efforts with SGM LIY. Although theoretical models propose that the intersectionality between legal involvement and SGM status may exacerbate minority stress, there are considerable gaps in understanding the mechanisms driving these youth disparities. This may be, in part, due to a lack of consistent and robust data collection with SGM youth involved in the legal system.5 A recent commentary by Ramos and colleagues identified the need to collect sexual and gender identity information, for example, in state and federal surveys. These data would better characterize identity-related risk and protective factors that could be used in intervention and prevention programming.5.

Caregiver and Juvenile Justice Personnel Perspectives on challenges and importance of caregiver engagement and the potential utility of a peer navigator program in the Juvenile Justice System.

BACKGROUND: For youth involved in the juvenile justice (JJ) system, caregiver involvement and engagement in the system is crucial for youth development and outcomes of JJ cases; however, there are challenges to establishing positive/productive partnerships between caregivers and JJ representatives. The current project examines perspectives of caregivers and JJ personnel regarding facilitators and barriers to establishing JJ-caregiver partnerships, as well as their perceptions of the use of a caregiver navigator program to support caregivers of system-involved youth. Results are used to inform development of a caregiver navigator program to support caregivers and help them navigate the JJ system. RESULTS: Semi-structured interviews were conducted with caregivers of youth involved in JJ (n = 15, 53% White, 93% female), JJ personnel (n = 7, 100% White, 50% female), and JJ family advisory board members (n = 5, 100% Black, 100% female). Caregivers reported varying experiences across intake/arrest, court, and probation processes. Positive experiences were characterized by effective communication and feeling supported by JJ. Negative experiences related to feeling blamed and punished for their child's system involvement and feeling unsupported. JJ interviews corroborated caregiver sentiments and also illustrated facilitators and barriers to JJ-caregiver partnerships. Both JJ personnel and caregivers endorsed potential benefits of a peer-based caregiver navigator program to provide social, informational, and emotional support. CONCLUSION: Continued work is needed to improve JJ-caregiver partnerships and use of a peer-based navigator program has the potential to address barriers to caregiver engagement in the JJ system.

Associations between outpatient treatment and the use of intensive psychiatric healthcare services.

The current manuscript examines concurrent and longitudinal associations between the utilization of outpatient and intensive psychiatric services among Medicaid-enrolled youth. Using an administrative dataset of Medicaid claims from 2007 to 2017, youth were included if they were between the ages of 10-18 (M = 13.4, SD = 2.6) and had a psychiatric Medicaid claim (N = 33,590). Psychiatric services were coded as outpatient, emergency department (ED), inpatient, or residential based on Medicaid codes. Logistic regression analyses indicated that the receipt of even one outpatient visit significantly reduced the odds of having an ED, inpatient, and residential visit within 60-, 90-, and 120-day windows. Survival analyses indicated most youth did not have any ED, inpatient, or residential visit following their first outpatient visit. For remaining youth, having an outpatient visit significantly increased the risk of having an ED, inpatient, and residential visit following their initial appointment, which may suggest these youth are being triaged to a more appropriate level of care. Classification accuracy analyses indicated a cutoff of 2 outpatient visits yielded maximum accuracy in determining youth with ED, inpatient, and residential visits. Findings highlight use of outpatient-level services in reducing risk of more intensive service utilization.

Examining Patterns of Psychotherapy Service Utilization Among Medicaid-Enrolled Adolescents.

OBJECTIVE: Adolescents with behavioral health disorders (i.e., mental health disorders and substance use) often experience frequent recurrence of symptoms, suggesting a need for an ongoing behavioral health intervention, rather than a single course of treatment. However, little is known about mental health care service use among adolescents over longer periods. The authors examined longitudinal patterns of outpatient behavioral health service utilization in a large sample of adolescents. METHODS: Medicaid claims for 8,197 adolescents (ages 10.0-13.9 years, mean±SD=11.5±1.2; 61% male) from one Indiana county between 2006 and 2017 were examined, with a focus on outpatient psychotherapy visits. Latent class analysis (LCA) was used to detect clusters of longitudinal patterns of outpatient psychotherapy visits across 5 years, beginning with an adolescent's first behavioral health visit. RESULTS: A five-class LCA model emerged with unique classes of service use based on duration and level of engagement (frequency) of monthly outpatient psychotherapy visits. Most adolescents fell in the nonuse class (38.7% of the sample). Additional classes were defined as late-onset low engagement (17.1%), early-onset high engagement (15.5%), early-onset moderate engagement (16.7%), and continuously high engagement (11.9%). Statistically significant differences were found across the classes in average duration and frequency of involvement (p<0.001), as well as in demographic characteristics (race, age, gender, and ethnicity) and behavioral health diagnoses (p<0.001). CONCLUSIONS: These findings confirm that adolescents with behavioral health diagnoses do not follow a uniform pattern of psychotherapy utilization. The distinct patterns of service use point toward the need to identify appropriate long-term service recommendations for adolescents.

Treatment completion among justice-involved youth engaged in behavioral health treatment studies in the United States: A systematic review and meta-analysis.

Justice-involved youth (JIY) have high rates of behavioral health disorders, but few can access, much less complete, treatment in the community. Behavioral health treatment completion among JIY is poorly understood, even within treatment studies. Measurement, reporting, and rates of treatment completion vary across studies. This systematic review and meta-analysis synthesizes the literature on rates of treatment completion among JIY enrolled in research studies and identifies potential moderators. After systematically searching 6 electronic databases, data from 13 studies of 20 individual treatment groups were abstracted and coded. A meta-analysis examined individual prevalence estimates of treatment completion in research studies as well as moderator analyses. Prevalence effect sizes revealed high rates of treatment completion (pr = 82.6). However, analysis suggests a high likelihood that publication bias affected the results. Treatment groups that utilized family- or group-based treatment (pr = 87.8) were associated with higher rates of treatment completion compared to treatment groups utilizing individual treatment (pr = 61.1). Findings suggest that it is possible to achieve high rates of treatment completion for JIY, particularly within the context of family- and group-based interventions. However, these findings are limited by concerns about reporting of treatment completion and publication bias.

Do suicidal thoughts and behavior persist following juvenile justice involvement?

INTRODUCTION: This study examines suicidal ideation and behavior of youth in the 3 months following their initial diversion appointment in the juvenile justice system. METHOD: Participants were 99 adolescents (72.7% female; 65% racial minority) between the ages of 12 and 18 (Mage = 15.06, SD = 1.35) and a parent/caregiver (80% female; 54% racial minority; Mage = 42.7 years, SD = 8.9 years). Participants were eligible if they endorsed two or more suicide items on a mental health screener (MAYSI-2) and were able to be contacted 3 months following initial court appointment. Youth and parent/caregiver responded to questionnaires assessing SI/SA, psychiatric symptoms, treatment motivation and engagement. RESULTS: Three months post-initial court appointment, more than half of youth (55.5%) continued to flag on the Suicide Ideation subscale of the MAYSI-2, though mean scores decreased from baseline to 3-months (t[97] = 5.74, p < 0.000, 95% CI [-0.79, 1.62] Cohen's d = 0.77). There were no significant differences in parent/youth treatment motivation or engagement regardless of SI at 3 months. CONCLUSIONS: Persistence of suicidal thoughts and behaviors beyond initial legal involvement highlights the importance of targeted suicide prevention interventions (beyond screening and referral to treatment) with justice-involved youth, even at first court contact.

Demographic Differences in Youth Perceptions of Staff: A National Evaluation of Adjudicated Youth.

Despite the large societal and personal cost associated with the detainment of juvenile offenders in residential facilities, little is known about the factors that contribute to youth behavior while incarcerated. One factor that may be of importance to maintaining security within facilities and improving rehabilitation efforts is youth's perceptions of correctional staff, namely, youth's perceptions of positive staff characteristics (e.g., friendliness; helpfulness) and staff behavior toward youth (e.g., fair punishments). Accordingly, the current study used the National Survey of Youth in Custody across two cohorts to better understand youth perceptions about staff by examining rates of these perceptions within juvenile detention centers nationwide. Furthermore, given the overrepresentation of marginalized groups in the justice system, systematic differences in youth's perceptions about staff were evaluated based on demographic characteristics, including age, race, sex, and sexual orientation, to better understand how these characteristics influence youth perceptions. Results suggested several significant differences based on demographic characteristics, with the most prominent and consistent differences associated with race and age, with Black youth and older youth having the least positive views of staff. Interestingly, non-heterosexual youth were more likely to view staff characteristics as positive than heterosexual youth. Implications of findings are discussed.

Implementation of a Behavioral Intervention in a Juvenile Detention Center: Do Individual Characteristics Matter?

A sample of 129 (73% male) youth admitted consecutively into a juvenile detention center were used to examine individual characteristics that contribute the implementation of a behavioral intervention within a juvenile detention center. Given that a system of rewards and punishments is considered the mechanism of change within many behavioral interventions, individuals risk characteristics (i.e., proactive and reactive aggression, behavioral inhibition, subsystems of behavioral activation, callous-unemotional traits, perceived containment) were examined in relation to the rewards (i.e., positive feedback) and punishments (i.e., fines) used by the facility. Data were collected via structured interviews with youth and archival data. The number of days youth spent in detention was the only predictor of positive feedback received. Number of days in detention, sex, and race were related to fines. Behavioral activation drive was the only individual characteristic related to fines. Implications of findings are discussed.

Bidirectional Associations between Peer Victimization and Functions of Aggression in Middle Childhood: Further Evaluation across Informants and Academic Years.

The current 3-wave study examined bidirectional associations between peer victimization and functions of aggression across informants over a 1-year period in middle childhood, with attention to potential gender differences. Participants included 198 children (51% girls) in the third and fourth grades and their homeroom teachers. Peer victimization was assessed using both child- and teacher-reports, and teachers provided ratings of reactive and proactive aggression. Cross-classified multilevel cross-lagged models indicated that child-reports, but not teacher-reports, of peer victimization predicted higher levels of reactive aggression within and across academic years. Further, reactive aggression predicted subsequent increases in child- and teacher-reports of peer victimization across each wave of data. Several gender differences, particularly in the crossed paths between proactive aggression and peer victimization, also emerged. Whereas peer victimization was found to partially account for the stability of reactive aggression over time, reactive aggression did not account for the stability of peer victimization. Taken together with previous research, the current findings suggest that child-reports of peer victimization may help identify youth who are risk for exhibiting increased reactive aggression over time. Further, they highlight the need to target reactively aggressive behavior for the prevention of peer victimization in middle childhood.