Sexual health variation among gang-involved youth in Washington state: Social ecological implications for research and practice.

INTRODUCTION: Gang-involved youth experience greater disparities in sexual health compared to non-gang-involved youth. Yet, little is known about how and why sexual behaviors vary within the youth gang population. Developing relevant and effective service approaches requires an understanding of this variation and the environmental factors that influence patterns of sexual health risk. METHODOLOGY AND RESULTS: Using latent class analysis, we identified four sexual behavior classes within a school-based sample of gang-involved youth in Washington State (N = 2060): Non-Sexually Active (54%), Limited Partners with Condom Use (14%), Multiple Partner with Sexting (19%), and High Sexual Vulnerability (13%). These classes were distinguished by age at sexual debut, number of sexual partners, condom use, and sexting. Interpersonal and macrosocial factors differentiated the classes, including multiform violence exposures, limited social support, and socioeconomic instability. We also found differences according to sexual identity and substance use. DISCUSSION: Findings highlight the need for service approaches that are responsive to both the individual needs of gang-involved youth and the factors that shape their living environments. We discuss the implications for research and practice, including the potential utility of a harm reduction framework to promote sexual health and reduce disparities in the youth gang population.

Protective Factors Against Aggression and Antisocial Attitudes Among Probation Youth with Childhood Adversity Histories.

Childhood adversity is linked to adolescent aggression and antisocial attitudes, which are common predictors of delinquency and violence. Early interruption of these negative trajectories is important for preventing serious criminality. Efforts to bolster protective factors such as social-emotional skills and positive relationships may attenuate this link, but research is needed to clarify salient factors for court-involved youth. Using risk assessment data for a diverse sample of youth on probation (N = 5378), this study investigated the role of adverse childhood experiences in increasing aggression and antisocial attitudes and the degree to which protective factors (self-regulation, future orientation, positive parenting, prosocial connections) mitigated those relationships. Multivariate models controlling for antisocial peers demonstrated that childhood maltreatment was the most salient form of adversity for increasing both aggression and antisocial attitudes. All protective factors were associated with reduced aggression and antisocial attitudes and, in moderation models, muted the impact of childhood adversity on both outcomes. These findings highlight the need for practice efforts geared toward bolstering protective factors for youth on probation, especially among those with child maltreatment histories.

Expert versus Youth Raters on Measuring Social and Therapeutic Climate in Secure Juvenile Placement.

Growing concern about the use of incarceration is driving significant reform in juvenile legal system decision-making and is likely to have a substantial impact on the role residential options play in the future continuum of care. It appears inevitable that surviving institutions or alternative residential models will be increasingly scrutinized for their impact on youth development. While rehabilitative models focused on youth development are a promising and growing part of residential institutions, few tools are available to measure quality. For institutions to sustain a focus on quality assessment, programs should use an organized and specified treatment model`` against which staff behavior can be assessed. This study examined the concurrent validity and item functioning of corresponding youth and expert ratings of social and therapeutic climate across multiple sites in a state-wide juvenile residential setting (n = 225 paired observations). Results suggest that the reliability of expert ratings of therapeutic climate exceeds the reliability of youth ratings, whereas reliability for other indicators of social climate are roughly equal between rater types. In addition, youth and expert ratings had weak concurrent validity. Implications for the use of youth versus expertly trained raters for measuring social and therapeutic environment are discussed.

Substance Use Profiles Among Gang-Involved Youth: Social Ecology Implications for Service Approaches.

Substance use is a frequently cited health risk behavior in the youth gang literature, yet little is known about how substance use patterns vary among gang-involved youth or the social ecological factors that contribute to potential variation. Developing relevant and effective service approaches will require an understanding of this variation and the malleable factors that are likely to promote or inhibit particular patterns of use. Using latent class analysis, we identified four substance use classes within a school-based sample of gang-involved youth (n = 2,770): Non-Users (38%), Past Users (15%), Casual Users (27%), and Frequent Multi-Users (21%). These classes were distinguished by substance type, frequency of use, and source of access. Demographic and substance use-specific ecological factors across the family, peer, school, and neighborhood contexts were found to significantly differentiate these classes. Specifically, acceptance of use by parents, friends, and neighbors, along with a lack of family rules and high accessibility in the neighborhood, significantly differentiated use patterns. Findings highlight the need for service approaches that are responsive to the unique needs of individuals and their environments. Implications for practice are discussed, including the potential utility of applying a harm reduction service framework to address youth gang substance use.

Neighborhoods and health during the transition to adulthood: A scoping review.

Research suggests that neighborhoods play an important role in shaping health outcomes across the life course, but the neighborhood-health link during the transition to adulthood period (18-29 years) is not well studied. A scoping review of 24 studies used thematic analysis to examine the theoretical and methodological approaches of the neighborhood-health literature during this period. Themes illustrate the varied approaches used in this research, including diversity in how neighborhood is defined, theoretical variation regarding the importance of the transition period and the neighborhood-health link, and the importance of gender and race/ethnicity to this area of study. While the literature on this topic is fragmented, with varied definitions and minimal theoretical coherence, all studies found some degree of support for the relationship between neighborhoods and health during the transition to adulthood. Our analysis suggests that future research should focus on developing a theoretical foundation for these relationships in order to clarify key concepts and advance a science to better understand how and why neighborhoods affect health during this period.

A tailored cognitive behavioral program for juvenile justice-referred females at risk of substance use and delinquency: A pilot quasi-experimental trial.

This pilot quasi-experimental trial tested a gender-responsive cognitive behavioral group intervention with 87 court-involved female adolescents (5 juvenile courts) who were at indicated risk for substance use disorder. Participants in the intervention (n = 57) received twice weekly group sessions for 10 weeks (20 sessions) focused on building emotional, thought and behavior regulation skills and generalizing these skills to relationally-based scenarios (GOAL: Girls Only Active Learning). Youth in the control condition (n = 30) received services as usual, which included non-gender-specific aggression management training, individual counseling and no services. The GOAL program was found to be acceptable to youth and parents and feasible to implement within a juvenile court setting using skilled facilitators. Compared to services as usual, the program significantly and meaningfully reduced self-reported delinquent behavior (ß = 0.84, p < 0.05) over 6 months, and exhibited trend level effects for reduced substance use (ß = 0.40, p = 0.07). The program had mixed or no effects on family conflict and emotion regulation skills. These findings are discussed in light of treatment mechanisms and gender-responsive services.

Developmental Pathways of Youth Gang Membership: A Structural Test of the Social Development Model.

As a result of nearly 40 years of research using a risk and protective factor approach, much is known about the predictors of gang onset. Little theoretical work, however, has been done to situate this approach to studying gang membership within a more comprehensive developmental model. Using structural equation modeling techniques, the current study is the first to test the capacity of the social development model (SDM) to predict the developmental pathways that increase and decrease the likelihood of gang membership. Results suggest that the SDM provides a good accounting of the social developmental processes at age 13 that are predictive of later gang membership. These findings support the promotion of a theoretical understanding of gang membership that specifies both pro- and antisocial developmental pathways. Additionally, as the SDM is intended as a model that can guide preventive intervention, results also hold practical utility for designing strategies that can be implemented in early adolescence to address the likelihood of later gang involvement. Three key preventive intervention points to address gang membership are discussed, including promoting efforts to enhance social skills, increasing the availability of prosocial opportunities and rewarding engagement in these opportunities, and reducing antisocial socialization experiences throughout the middle- and high school years.

The Impact of Psychiatric Practice Guidelines on Medication Costs and Youth Aggression in a Juvenile Justice Residential Treatment Program.

OBJECTIVE: Stakeholders have expressed concern over the appropriate use of psychiatric medications and adequacy of mental health services for youths involved with the juvenile justice system. This study assessed the impact of implementing psychiatric practice guidelines on medication costs and youth aggression in a juvenile justice facility. The study examined whether implementing psychiatric practice guidelines in a facility with an organized psychosocial treatment program would reduce psychiatric medication costs, compared with two other facilities, and whether lower psychotropic medication costs would be associated with increases in youth aggression. METHODS: Administrative data from three state-run juvenile justice facilities were analyzed to determine psychiatric medication costs and rates of youth aggression. Psychiatric practice guidelines that involved screening, shared decision making, psychosocial treatments, medication prescribing, and monitoring of side effects were implemented in only one of the three facilities, with a goal of applying evidence-based psychopharmacology and benefit-risk considerations. RESULTS: Over the ten-year study period (2003-2012), psychiatric medication costs decreased 26% at the facility implementing the psychiatric practice guidelines, whereas costs at the two comparison facilities increased by 104% and 152%. As psychiatric medication costs decreased at the facility implementing the guidelines, youth aggression there did not increase. CONCLUSIONS: Implementing psychiatric practice guidelines in juvenile justice facilities can reduce psychotropic medication costs without an increase in youth aggression. Implementation of the guidelines requires an organized psychosocial treatment program to help deter an inappropriate focus on psychotropic treatments.

A Research Framework for Understanding the Practical Impact of Family Involvement in the Juvenile Justice System: The Juvenile Justice Family Involvement Model.

Family involvement is recognized as a critical element of service planning for children's mental health, welfare and education. For the juvenile justice system, however, parents' roles in this system are complex due to youths' legal rights, public safety, a process which can legally position parents as plaintiffs, and a historical legacy of blaming parents for youth indiscretions. Three recent national surveys of juvenile justice-involved parents reveal that the current paradigm elicits feelings of stress, shame and distrust among parents and is likely leading to worse outcomes for youth, families and communities. While research on the impact of family involvement in the justice system is starting to emerge, the field currently has no organizing framework to guide a research agenda, interpret outcomes or translate findings for practitioners. We propose a research framework for family involvement that is informed by a comprehensive review and content analysis of current, published arguments for family involvement in juvenile justice along with a synthesis of family involvement efforts in other child-serving systems. In this model, family involvement is presented as an ascending, ordinal concept beginning with (1) exclusion, and moving toward climates characterized by (2) information-giving, (3) information-eliciting and (4) full, decision-making partnerships. Specific examples of how courts and facilities might align with these levels are described. Further, the model makes predictions for how involvement will impact outcomes at multiple levels with applications for other child-serving systems.