How much does that cost? Examining the economic costs of crime in North America attributable to people with psychopathic personality disorder.

Cost of illness research has established that mental disorders lead to significant social burden and massive financial costs. A significant gap exists for the economic burden of many personality disorders, including psychopathic personality disorder (PPD). In the current study, we used a top-down prevalence-based cost of illness approach to estimate bounded crime cost estimates of PPD in the United States and Canada. Three key model parameters (PPD prevalence, relative offending rate of individuals with PPD, and national costs of crime for each country) were informed by existing literature. Sensitivity analyses and Monte Carlo simulations were conducted to provide bounded and central tendency estimates of crime costs, respectively. The estimated PPD-related costs of crime ranged from $245.50 billion to $1,591.57 billion (simulated means = $512.83 to $964.23 billion) in the United States and $12.14 billion to $53.00 billion (simulated means = $25.33 to $32.10 billion) in Canada. These results suggest that PPD may be associated with a substantial economic burden as a result of crime in North America. Recommendations are discussed regarding the burden-treatment discrepancy for PPD, as the development of future effective treatment for the disorder may decrease its costly burden on health and justice systems. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Risk and protective factors for offending among UK Armed Forces personnel after they leave service: a data linkage study.

BACKGROUND: A proportion of ex-military personnel who develop mental health and social problems end up in the Criminal Justice System. A government review called for better understanding of pathways to offending among ex-military personnel to improve services and reduce reoffending. We utilised data linkage with criminal records to examine the patterns of offending among military personnel after they leave service and the associated risk (including mental health and alcohol problems) and socio-economic protective factors. METHOD: Questionnaire data from a cohort study of 13 856 randomly selected UK military personnel were linked with national criminal records to examine changes in the rates of offending after leaving service. RESULTS: All types of offending increased after leaving service, with violent offending being the most prevalent. Offending was predicted by mental health and alcohol problems: probable PTSD, symptoms of common mental disorder and aggressive behaviour (verbal, property and threatened or actual physical aggression). Reduced risk of offending was associated with post-service socio-economic factors: absence of debt, stable housing and relationship satisfaction. These factors were associated with a reduced risk of offending in the presence of mental health risk factors. CONCLUSIONS: Ex-military personnel are more likely to commit violent offences after leaving service than other offence-types. Mental health and alcohol problems are associated with increased risk of post-service offending, and socio-economic stability is associated with reduced risk of offending among military veterans with these problems. Efforts to reduce post-service offending should encompass management of socio-economic risk factors as well as mental health.

Criminal justice system involvement and food insufficiency: findings from the 2018 New York City Community Health Survey.

PURPOSE: To assess whether personal and family history of criminal justice (CRJ) involvement is related to food insufficiency. METHODS: Data are from the 2018 New York City Community Health Survey (n = 9580). Cross-sectional multinomial logistic regression was used to analyze the association between CRJ involvement and food insufficiency. RESULTS: Personal (relative risk ratio= 2.019, 95% confidence interval = 1.363, 2.994) and family history (relative risk ratios = 1.447, 95% confidence interval = 1.014, 2.066) of CRJ involvement is associated with a higher likelihood of experiencing moderate-to-severe food insufficiency, net of covariate for demographic and socioeconomic characteristics. CONCLUSION: Developing interventions such as expanding access to nutrition assistance programs for criminal justice involved populations may yield benefits for alleviating food insufficiency and promoting greater health equity.

Socio-Structural and Neighborhood Predictors of Incident Criminal Justice Involvement in a Population-Based Cohort of Young Black MSM and Transgender Women.

Black men who have sex with men (MSM) and transgender women are disproportionately affected by criminal justice involvement (CJI) and HIV. This study recruited 618 young Black MSM and transgender women in Chicago, IL, using respondent-driven sampling between 2013 and 2014. Random effects logistic regression evaluated predictors of incident CJI over 18 months of follow-up. Controlling for respondent age, gender and sexual identity, spirituality (aOR 0.56, 95% CI 0.33-0.96), and presence of a mother figure (aOR 0.41, 95% CI 0.19-0.89) were protective against CJI. Economic hardship (financial or residential instability vs. neither aOR 2.23, 95% CI 1.10-4.51), two or more past episodes of CJI vs. none (aOR 2.66, 95% CI 1.40-5.66), and substance use (marijuana use vs. none aOR 2.79, 95% CI 1.23-6.34; other drug use vs. none aOR 4.49, 95% CI 1.66-12.16) were associated with CJI during follow-up. Research to identify and leverage resilience factors that can buffer the effects of socioeconomic marginalization may increase the effectiveness of interventions to address the socio-structural factors that increase the risk for CJI among Black MSM and transgender women. Given the intersection of incarceration, HIV and other STIs, and socio-structural stressors, criminal justice settings are important venues for interventions to reduce health inequities in these populations.

Covariates of hazardous alcohol use among sexual and gender minorities in Texas: Identifying the most vulnerable.

BACKGROUND: Information is limited on the prevalence of hazardous drinking and associated covariates among sexual and gender minority (SGM) persons. These analyses estimated the prevalence of hazardous drinking and identified associated covariates. METHODS: A total of 1273 SGM adolescents and adults living in Texas completed an online survey between March 2016 and January 2017. Variables associated with hazardous drinking at the bivariate-level (p < 0.10) were entered into multiple logistic regression models to estimate the strength of their association. RESULTS: More than a third (39.1%) of participants meet criteria for hazardous drinking. Compared to non-hazardous drinkers, hazardous drinkers were younger (x- = 20.7 [SD = 8.9] vs. x- = 26.5 [SD = 13.8]) and more likely to be Hispanic (41.5% vs. 26.2%). Hazardous drinkers were more likely to report using substances in past 12 months, including opioids (15.3% vs. 6.7%), stimulants (26.3% vs. 12.7%), and marijuana (37.6% vs. 21.2%). More hazardous drinkers reported injecting drugs (12.3% vs. 5.8%) and having a history of incarceration (14.1% vs. 7.3%). They were less likely to be diagnosed with depression (50.2% vs. 56.5%). When entered into a multivariate logistic regression model, hazardous drinkers were more likely to be younger (aOR = 0.97 [0.95, 0.98]), Hispanic (aOR = 1.5 [1.2, 2.0]), have a history of incarceration (aOR = 2.4 [1.5, 3.6]), and use a substance, not including marijuana (aOR = 1.7 [1.3, 2.3]). They were less likely to be diagnosed with depression (aOR = 0.73 [0.6, 0.9]). CONCLUSIONS: Our findings highlight the intersection of race and ethnicity, mental health, criminal justice involvement, and substance use and the need for tailored interventions that address underlying determinants.

Gender Differences in Health Care Needs and Service Attainment Among Violent Offenders.

Research has determined that female inmates experience distinctive challenges both during and after incarceration. There has been little empirical inquiry, however, into the gendered nature of medical health care needs and treatment postrelease. The purpose of this study, therefore, is to examine the differences between male and female inmates with regard to chronic illness diagnoses and health care receipt during reentry. This was done using a subsample of 763 inmates who participated in the Serious and Violent Offender Reentry Initiative multisite impact evaluation who specifically mentioned a need for medical health care treatment. Results of multivariate analyses showed gendered differences for both chronic illness diagnoses and medical treatment receipt postrelease, thus highlighting potential implications for correctional health care policy and resource distribution.

Racial/ethnic and gender disparities in anger management therapy as a probation condition.

OBJECTIVE: This study examined whether race/ethnicity and gender predicted sentencing to anger management therapy as a probation condition. HYPOTHESES: We predicted judges would be more likely to assign African Americans and Hispanics, and males to anger management than Caucasians and women, respectively. We hypothesized demographic variables would predict assignment to anger management beyond legal and nondefendant extralegal variables. METHOD: Data for this study are administrative and originate from an adult probation department in southern Texas. The sample (N = 4,001; 72.3% male) was 53.4% Caucasian, 28.6% African American, 16.7% Hispanic, 0.9% other, and 0.4% unknown and included individuals who had committed violent (14.2%) and nonviolent (85.8%) offenses. RESULTS: Data analyses consisted of binary logistic regression, with anger management placement as the dependent variable, and offense, judge, county, race/ethnicity, and gender as the independent variables. The final model emerged as statistically significant, χ²(16) = 552.76, p < .001, Nagelkerke's R² = .32. Specifically, the odds of receiving anger management were 1.71 times higher for African Americans than Caucasians, and 1.68 times higher for men than women. Exploratory analyses examining a Race/Ethnicity × Gender interaction revealed the odds of receiving anger management was significantly lower for Caucasian women than all other racial/ethnic by gender groups. CONCLUSION: Results suggest being part of a racial/ethnic minority group or male may disproportionately increase the odds of being required to comply with extra time and fiscal requirements associated with anger management as compared to one's racial/ethnic and gender counterparts who have committed similar crimes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

An Exploration of Service Providers' Experiences With Latinos Convicted of a Sex Offense.

Despite the growing Latino presence in the U.S. criminal justice system and among those who have committed sex offenses specifically, little is known about the barriers and challenges faced by this population when accessing treatment services. This study sought to gather more information about responsivity factors that may be specific to Latinos who have committed sexual offenses. Service providers who worked with Latinos convicted of sexual offenses completed an online survey and answered questions regarding perceived challenges and barriers they encountered when working with Latino clients and were asked to provide recommendations concerning services and treatment provision. Service providers frequently reported issues related to a lack of culturally sensitive services, bilingual professionals, and clients' limited knowledge about the U.S. legal system. Among service providers with experience working with undocumented Latino immigrants, some indicated specific challenges such as stressors related to their immigration status and a lack of resources. Professionals' recommendations were consistent with the challenges reported and findings are discussed as they pertain to responsivity issues in the provision of treatment services to Latino individuals who have committed sexual offenses.

Characteristics of Intimate Partner Homicide in China: Compared With Previous Studies in Other Countries.

Advancing towards modernization and urbanization, China is currently witnessing a soaring increase in intimate partner homicide (IPH). The present study sought to explore the characteristics of IPHs in China. Data from 979 judgments of this lethal serious crime were analyzed. In comparison with studies from other parts of the world, this study determined the characteristics of IPHs in China in terms of perpetrators, victims, incidents, and types of intimate relationships. Although the previous theoretical research has given reasonable explanations for IPHs, the relationship between perpetrator and victim is actually a neglected area in the study of IPHs. In this study, we found that the relationship between them played a leading role in understanding IPHs in China.

Police contact and health among urban adolescents: The role of perceived injustice.

This research evaluates whether personal and vicarious police contact are related to self and caregiver-reports of teen health and to what extent these associations vary by perceptions of procedural injustice. We analyzed longitudinal health data collected from adolescents in the Fragile Families and Child Wellbeing Study (N = 3435), alongside teen self-reports of whether they were stopped by the police or experienced vicarious police contact, and if so, their perceptions of procedural injustice in these encounters. We estimated regression models with lagged dependent variables and a propensity score weighting approach. Our analysis yielded four important results. First, participants who reported personal or vicarious police stops had worse self-reported health in adolescence than their counterparts with no contact. Second, both types of police contact were unrelated to caregiver reports of adolescent health and inconsistently related to somatic symptoms. Third, procedural injustice exacerbated the relationship between both personal and vicarious contact and diminished self-reported health. Finally, the associations between police contact and self-reported health were stronger among black and Hispanic adolescents than white ones. Our results highlight personal and vicarious police contact, particularly instances viewed as procedurally unjust, as commonly experienced adverse health events among urban adolescents.

Arrest and Trait Aggression Correlates of Emergency Department Use.

This study examined the associations between arrest and incarceration, trait aggression, and emergency department (ED) use. Data were collected from 525 clients who visited the Center for Behavioral Research and Services in Long Beach, CA, using the following instruments: Risk Behavior Assessment, Risk Behavior Follow-Up Assessment, the Aggression Questionnaire (AQ), the Displaced AQ, and the parole and Legal Status section of the Addiction Severity Index. The bivariate analysis suggested that ED use was significantly associated with trait aggression and trait-displaced aggression among those with a history of incarceration. In the logistic regression, weapons offenses, manslaughter/homicide, being male, and being Black were significantly associated with ED use. Identification and management of aggressive trait personality are important in improving the management of postrelease care in transition to clinical networks and community-based health care settings.

A Comparative Analysis of the Risk Profiles of Australian Young Offenders From Rural and Urban Communities.

Australian young people from rural areas, particularly Aboriginal young people, are overrepresented in the juvenile justice system. Apart from broad evidence regarding the entrenched social disadvantages experienced by young people in rural communities, the literature is limited in describing why this might be case. Due to these social disadvantages, it is hypothesised that young offenders from rural communities will have higher levels of offending risk factors, as measured by the Youth Level of Service/Case Management Inventory-Australian Adaption (YLS/CMI-AA). A total of 6,750 archival records were analysed, showing that significantly more Aboriginal young offenders live in rural areas. Contrary to the hypothesis, urban young offenders had significantly higher risk scores than rural young offenders. These findings suggest that there may be particular ecological factors that are not assessed in the current risk assessment instrument or that rural young people have a range of protective factors that may insulate against the broader context of social disadvantage.

Mental Health Treatment Among Individuals Involved in the Criminal Justice System After Implementation of the Affordable Care Act.

OBJECTIVE: The objective of this study was to assess changes in health insurance coverage and mental health treatment among individuals with and without involvement in the criminal justice system after implementation of key provisions of the Affordable Care Act (ACA). METHODS: Data from the National Survey on Drug Use and Health were used to assess changes in coverage, mental health treatment, and payer between 2011-2013 and 2014-2017 for nonelderly adults (ages 19 to 64) with and without criminal justice involvement in the past year who reported serious psychological distress. Multivariable logistic regression was used to obtain adjusted estimates. RESULTS: The weighted sample represented, on average, 2.0 million individuals with criminal justice involvement (total unweighted N=3,688) and 20.9 million without criminal justice involvement (total unweighted N=33,872) in each study year. Following implementation of the ACA's key provisions, health insurance coverage increased by 13.4 percentage points (95% CI=8.5-18.3) among individuals with past year criminal justice involvement and by 8.1 percentage points (95% CI=6.9-9.4) among those without. Receipt of any mental health treatment did not change significantly among individuals with criminal justice involvement (-3.4 percentage points [95% CI=-8.0 to 1.1]), whereas it increased significantly in the general population (2.2 percentage points [95% CI=0.4-3.9]). CONCLUSIONS: Despite an increase in health insurance coverage for people with criminal justice involvement, there was no increase in mental health treatment following implementation of the ACA's key provisions. Health insurance coverage is necessary, but not sufficient, to expand access to mental health treatment for individuals involved in the criminal justice system.

A qualitative assessment of a dog program for youth offenders in an adult prison.

OBJECTIVE: Dog programs occurring in prison tend to generate positive public opinion and media portrayals, yet they often lack empirical validation. This is the first study to examine the key themes that drive a dog program aimed at incarcerated youth serving time in an adult prison. DESIGN AND SAMPLE: A sample of male youth (n = 31) were provided survey questions on a rescue dog program. A grounded qualitative approach was employed with open-ended responses. RESULTS: The following themes emerged: the symbolism of the dog its role in therapy, perceptions of positive behaviors and rehabilitation, a sense of normality, and universal support by inmates. CONCLUSION: This study supports the potential for utilizing rescue dogs in therapeutic interventions in which the vulnerable inmate can discuss early trauma, interpersonal dysfunction and histories of deviance. The dog symbolized the potential for incarcerated youth to engage in discussion of sensitive topics in a safe manner. Policy implications also include the function of dogs in creating a normalizing effect on the prison unit itself, one that can promote rehabilitation. There was universal support for the program which is rare in the prison milieu. Theoretically, positive outcomes occurred in an indirect manner, though more research is needed.

Women Released From Custody: Investigating Risk Factors and Reoffending.

This article draws on life-course and desistance theory to explore the relationship between the factors of age, ethnicity, offence type, and incarceration history for a sample of 1,035 women released from custody between January 2013 and January 2014, data gathered from the Australian Queensland Corrective Services administrative dataset. It also explores their impact on recidivism and the time between release and reoffending (known as "time to failure") until September 2017. The data indicate substantial rates of reoffending with 70% of the sample reoffending (a return to custody/parole/probation) within the 2- to 4-year observation period. Notably, 50% of women reoffended in their first year post-release, 36% within 6 months, and 23% within the first 3 months. Regression results show that violent offenders are considerably more likely to be recidivists and older offenders are less likely to be recidivists; Aboriginal and Torres Strait Islander offenders were also more likely to reoffend. Incarceration history is significantly associated with reoffending and "time to failure". It is clear that there needs to be increased intervention and support for female offenders during the first 2 years post-release from custody. This is particularly important for Aboriginal and Torres Strait Islander women and those with an extensive history of incarceration.

Effects of a voter initiative on disparities in punishment severity for drug offenses across California counties.

BACKGROUND: The jurisdiction where an offense is prosecuted significantly affects the severity of punishment for drug possession, creating geographic disparities in exposure to a social determinant of health. In California, felony conviction rates after drug possession arrests have historically varied enormously between counties. California Proposition 47 (Prop-47), passed in 2014, reduced drug possession offenses previously classified as felonies or wobblers (offenses for which prosecutors have discretion to file felony or misdemeanor charges) to misdemeanors. This study examines whether geographic variation in felony convictions after drug possession arrests was reduced, and whether effects were offset by changes in felony convictions for other offenses not addressed by Prop-47. METHODS: Arrests made after the implementation of Prop-47 were propensity score matched to similar arrests prior to Prop-47 to account for compositional changes in arrests. This approach compares the outcomes of individuals likely to be arrested with or without the reclassification of drug offenses. We used mixed models to estimate the change in county variance in the probability of felony conviction. RESULTS: The probability of a felony conviction among those arrested for Prop-47 drug offenses declined by 14 percentage points (95% CI: -0.16, -0.12), from 0.20 (95% CI: 0.18, 0.23) to 0.06 (95% CI: 0.06, 0.07). Counties with higher felony conviction probabilities pre-Prop-47 declined most, reducing cross-county variance. For those arrested for drug offenses unaffected by Prop-47, the probability of felony conviction declined by 7 percentage points (95% CI: -0.08, -0.05), from 0.34 (95% CI: 0.31, 0.37) to 0.27 (0.25, 0.29). Declines in both groups were driven by fewer felony convictions for Prop-47 drug offenses, with no increases in felony convictions for concurrent offenses. CONCLUSION: Reducing offense classifications for drug possession reduced previously large differences in the probability of felony convictions for people arrested for drug offenses in different counties.

Association of Criminal Statutes for Opioid Use Disorder With Prevalence and Treatment Among Pregnant Women With Commercial Insurance in the United States.

Importance: Inadequate treatment of opioid use disorder (OUD) in pregnant women increases the risk of life-threatening consequences on maternal and fetal outcomes. Untreated OUD during pregnancy is associated with higher rates of adverse outcomes among newborns. Objective: To examine the variation in the prevalence of OUD and the use of medication-assisted treatment among commercially insured pregnant women according to region and state legislature. Design, Setting, and Participants: Cohort study in which the patient cohort used was derived from a 10% random sample of enrollees within the IQVIA PharMetrics Plus adjudicated claims and enrollment database from 2007 to 2015. The database consists of a 10% random sample of private health insurance recipients in the United States and contains claims and enrollment data that are representative of the commercially insured US population. The cohort comprised women (n = 110 285) between 18 and 45 years of age with a code indicating a delivery and continuous insurance enrollment 9 months before and 12 months after delivery. Data analysis was performed from December 2017 to May 2018. Exposures: Based on their state of residence, the women were classified into 4 different regions: South, Midwest, West, and Northeast. Those residing in states with statutes that imposed civil or criminal penalties for OUD diagnosis during pregnancy were placed in a separate population from those residing in states without these statutes. Main Outcomes and Measures: Diagnosis of OUD in the 9 months before delivery and the receipt of medication-assisted treatment in the 9 months before or 12 months after delivery. Results: The 110 285 pregnant women included in the analysis had a mean (SD) age of 30.26 (5.59) years, with most (67 771 [61.5%]) falling within the 26- to 35-year age range. Of this cohort, 277 women (0.25%) had a diagnosis of OUD and 312 (0.28%) received treatment. Among the 277 women with OUD, 127 (45.9%) received treatment. The prevalence of an OUD diagnosis and receipt of treatment within regions was statistically significant (OUD diagnosis by region: Midwest, 0.05%; North, 0.09%; South, 0.06%; West, 0.06%; χ23 = 45.1148 [P < .001]; OUD treatment by region: Midwest, 0.05%; North, 0.08%; South, 0.10%; West, 0.05%; χ23 = 26.5654 [P < .001]). The prevalence of OUD diagnosis was also statistically significant when comparing women residing in states with statutes with those in states without statutes (OUD diagnosis by criminal statutes: criminalization, 0.07%; no criminalization, 0.18%; χ21 = 14.6456 [P < .001]; OUD treatment by criminal statutes: criminalization, 0.12%; no criminalization, 0.17%; χ21 = 0.0895); the receipt of treatment was not statistically significant (P = .76). Conclusions and Relevance: These results appeared to show significant variations in the patterns of OUD diagnosis and receipt of medication-assisted treatment among pregnant women, suggesting the need to further explore the source of these variations.

Assessing societal and offender perspectives on the value of offender healthcare: a stated preference research protocol.

INTRODUCTION: The increasing burden that offenders place on justice and health budgets necessitates better methods to determine the benefits of and value society places on offender programmes to guide policy regarding resource allocation. The aim of this paper is to demonstrate how economic methods will be used to determine the strength of preferences and value of violent offender treatment programmes from the perspectives of offenders, their families and the general population. METHODS AND ANALYSIS: Two stated preference economic methods, discrete choice experiment (DCE) and contingent valuation (CV), will be used to assess society's and offenders' value of treatment programmes. The mixed methods process involves a literature review and qualitative methods to derive attributes and levels for the DCE and payment card values for the CV. Consensus building approaches of voting, ranking and the Delphi method will be used to further refine the findings from the qualitative phase. Attributes and their levels will be used in a D-efficient Bayesian experimental design to derive choice scenarios for the development of a questionnaire that will also include CV questions. Finally, quantitative surveys to assess societal preferences and value in terms of willingness to pay will be conducted. ETHICS AND DISSEMINATION: Ethics approval for this study was obtained from the University of New South Wales (UNSW) Human Research Ethics Committee, Corrective Services New South Wales Ethics Committee and the Aboriginal Health and Medical Research Council ethics committee. The findings will be made available on the Kirby Institute UNSW website, published in peer-reviewed journals and presented at national and international conferences.

The significance of the forensic clinical examination on the judicial assessment of rape complaints - developments and trends.

OBJECTIVE: The aim of this study was to investigate the role of the forensic clinical examination in the judicial assessment made by the Prosecution Service in cases of rape. METHODS: All cases of police-reported sexual assault in the county of Funen, Denmark in a six-year period were reviewed, and the retrospective data was collected. Cases in which a forensic clinical examination was performed were included. RESULTS: The Prosecution Service in the county of Funen received 348 police-reported rape cases and of these 184 cases were included. The Prosecution Service stated that the forensic clinical examination (FCE) was important for the decision-making process in approximately half of the cases. The Prosecution Service finding an FCE important due to the presence of relevant findings was significantly associated with the case going to trial, whereas importance due to absence of relevant findings was significantly associated with the cases not going to trial. The only single factor associated with a case going to court and a guilty verdict was an FCE of the alleged perpetrator. There were no crude associations between any other factors i.e. the type of assault, victim injuries or alcohol consumption. In a logistic regression model, however, it was significantly more likely (p < 0.05) that a forensic clinical examination of the victim was used in the Prosecution Service's decision if there were both anogenital and extra-genital injuries documented, that could originate from the alleged crime. The odds were 7.83 times higher compared to if no injuries were detected. The Prosecution Service's use of the clinical examination in their argumentation of the decision of a rape complaint has been significantly increasing from 2003 to 2015. CONCLUSION: The results of the first in-depth analysis of the overall importance of a forensic clinical examination in cases of rape and sexual assault shows that we need to continuously focus on the documentation of sexual assault, as documentation is part of the decision-making process at all stages of the judicial process.

Use of Manifest Injustice in the Washington State Juvenile Rehabilitation Administration.

In the Washington State Juvenile Code, the Manifest Injustice (MI) provision allows judges to sentence youth outside of the standard guidelines. We compared rates of Juvenile Rehabilitation Administration (JRA) involvement and MI between racial minority youth and Caucasian youth. Although not statistically significant, there was a trend toward African American and multiracial youth having MI used to decrease their sentence less frequently than Caucasian youth. African American youth were about half as likely to have MI used to intensify their sentence compared with Caucasian youth (rate ratio = .49, p = .002), whereas multiracial youth were 42 percent less likely (rate ratio = .58, p = .04). More African American youth reside in urban and liberal parts of the state where judges may be more progressive and less likely to use MI to intensify sentences. More diversion programs targeting minority youth exist in urban areas of Washington, and more African American youth are transferred to adult court; both reduce the likelihood of minority youth receiving MI. Judges in rural areas of the state, which have fewer treatment resources, may be using MI to access services only available to court-involved youth. It is imperative that community behavioral health services are available so that youth and families can be justly served.