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INTRODUCTION: Engaging families in behavioral health services is a high priority for juvenile justice (JJ) systems and family advocacy groups. Family-driven care (FDC) enhances family engagement and decision-making power in youth behavioral health services, ultimately, improving youth and family mental health and substance abuse outcomes. Despite the benefits, there is limited guidance on how to integrate FDC into behavioral health care within the JJ system. Therefore, the goal of this study is to understand factors that promoted adoption of FDC the JJ context. METHODS: JJ staff and leadership across the state of Georgia participated in surveys and interviews to understand contextual implementation determinants related to the adoption of FDC. Between November 2021- July 2022, 140 JJ staff participated in the survey from 61 unique JJ organizations. In addition, 16 staff participated in follow-up key informant interviews to explain quantitative findings. RESULTS: Based on a mixed methods analysis, JJ agencies were more likely to implement FDC if they had the following characteristics: (1) presence of site leaders that were strongly committed to family engagement, (2) a shared understanding that family engagement was a top priority, (3) staff training related to family engagement, (4) external partnerships with organizations that serve families, (5) a workplace culture that was supportive of innovation, and (6) presence of family engagement programs that were easier (or more feasible) for staff to implement. DISCUSSION: This mixed methods study underscores the importance of strengthening these 6 inner and outer setting implementation determinants when preparing to integrate FDC into JJ systems. Findings are used to promote the adoption and delivery of this high priority intervention in a state-level JJ system.
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[This corrects the article DOI: 10.3389/fpsyg.2023.1194294.].
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The goal of our study was to describe the availability of community child and adolescent mental health services, trauma-informed care, and the geographic accessibility of these services for juvenile justice-involved (JJ) youth who received mental health services while in secure detention. Data collection occurred through direct contact with the child and adolescent outpatient clinics listed on the New York State Office of Mental Health website. Zip codes were collected from the juvenile secure detention census. Of the clinics contacted, 88.5 percent accepted JJ youth; however, 43.5 percent accepted them on a conditional basis. Only 62.1 percent offered trauma-informed care, including evidence-based interventions and unspecified care. Although 84.5 percent of the clinics that would accept this population reported currently accepting new patients, reported wait times were as high as six or more months. When JJ residents' home zip codes and those of the clinics were geographically mapped, there were few clinics in the zip codes where most residents lived. The clinics that accepted youth on a conditional basis often refused high-risk patients, essentially ruling out a large majority of this population. The geographical inaccessibility of these clinics limits their ability to provide care for this vulnerable population.
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The purpose of this study was to examine the impact of childhood trauma exposure, posttraumatic stress disorder, and trauma-related comorbid diagnoses on the risk for readmission to juvenile detention among youth in a large metropolitan area (N = 1282). The following research questions were addressed: 1) Does a greater number of childhood traumas increase the risk for readmission to detention following release? 2) Does the risk for readmission differ by type of trauma? 3) Do PTSD and other co-morbid diagnoses increase the risk for readmission? and 4) What role do demographic factors play in the relationship between trauma-related variables and risk for readmission? This study utilized the screening results of 1282 youth who were voluntarily screened for PTSD, depressive symptoms and substance use during their initial intake to detention. More than half of the sample was readmitted during the three-year study period, with readmissions most likely to occur within one year of release. Returning to detention within one year was also associated with increased risk for multiple readmissions. Youth readmitted to detention were more likely to have a history of sexual abuse and problematic substance use. No other significant relationships were found between risk for readmission and trauma-related variables. Although trauma-related symptoms may be crucial targets for treatment, focusing solely on trauma exposure and traumatic stress symptoms without considering the impact of other risk factors may not be enough to decrease the likelihood of readmission for youth of color in a large urban environment.
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This article examines the epidemiology of the US juvenile legal system, which disproportionately impacts youth with multiple marginalized identities and exacerbates health inequities. Policy changes that can improve the treatment of children who display disruptive behavior are highlighted, so as to lay out a path forward for supporting children and enhancing health equity while bolstering public safety. Finally, this article concludes that the systemic racism pervasive in the juvenile legal system signals an important role for pediatrics to advance racial equity and transform our approach to childhood.
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Delinquência Juvenil , Humanos , Estados Unidos , Criança , Adolescente , Delinquência Juvenil/legislação & jurisprudência , Racismo Sistêmico/prevenção & controleRESUMO
BACKGROUND: Research demonstrates gaps in medications for opioid use disorder uptake (MOUDs; methadone, buprenorphine, and naltrexone) especially among adolescents. These gaps may be partly attributable to attitudes about and training in MOUDs among youth-serving professionals. We extended prior research by conducting descriptive analyses of attitudes regarding effectiveness and acceptability of MOUDs, as well as training in MOUDs, among youth legal system (YLS) employees and community mental health center (CMHC) personnel who interface professionally with youth. METHODS: Using survey data from participants (n = 181) recruited from eight Midwest counties, we examined: (1) differences in MOUD attitudes/training by MOUD type and (2) by respondent demographics, and (3) prediction of MOUD attitudes/training by participant-reported initiatives to implement evidence-based practices (EBPs), workplace culture around EBPs, and workplace stress. Attitudes and training were measured in reference to five MOUD types (methadone, oral buprenorphine, injectable buprenorphine, oral naltrexone, injectable naltrexone) on three subscales (effectiveness, acceptability, training). RESULTS: Wilcoxon signed-rank tests demonstrated that most outcomes differed significantly by MOUD type (differences observed among 22 of 30 tests). Kruskal-Wallis tests suggested MOUD differences based on demographics. For methadone, CMHC providers endorsed greater perceived effectiveness than YLS providers and age explained significant differences in perceived effectiveness. For buprenorphine, CHMC providers viewed oral or injectable buprenorphine as more effective than YLS employees, respondents from more rural counties viewed oral buprenorphine as more effective than those from less rural counties, and age explained differences in perceived effectiveness. For naltrexone, perceived gender differed by gender. Hierarchical ordinal logistic regression analysis did not find an association between personal initiatives to implement EBPs, workplace culture supporting EBPs, or workplace stress and effectiveness or acceptability of MOUDs. However, personal initiatives to implement EBPs was associated with training in each MOUD. CONCLUSIONS: These results highlight a few key findings: effectiveness/acceptability of and training in MOUDs largely differ by MOUD type; setting, rurality, age, gender, and education explain group differences in perceived effectiveness of and training in MOUDs; and implementing EBPs is associated with training in MOUDs. Future research would benefit from examining what predicts change in MOUD attitudes longitudinally.
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Atitude do Pessoal de Saúde , Buprenorfina , Naltrexona , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Humanos , Masculino , Feminino , Adulto , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Naltrexona/uso terapêutico , Buprenorfina/uso terapêutico , Metadona/uso terapêutico , Centros Comunitários de Saúde Mental , Adolescente , Pessoa de Meia-Idade , Adulto Jovem , Antagonistas de Entorpecentes/uso terapêuticoRESUMO
PURPOSE: Investigate if the type of substance use disorder (SUD) in adolescence predicts SUDs in adulthood and examine sex and racial/ethnic differences in the persistence of SUDs. METHODS: Data are from the Northwestern Juvenile Project, a 15-year longitudinal study of 1829 youth randomly sampled from detention in Chicago, IL (1995-1998). Interviewers assessed SUDs using structured diagnostic interviews. RESULTS: Compared with females without an SUD at detention, females with cannabis alone, comorbid alcohol and cannabis, or SUDs other than alcohol and cannabis at detention had higher odds of having an SUD 5 years later (25%, 32%, and 36% vs. 15%, adjusted odds ratio [AOR] = 1.94, 95% confidence interval [CI] 1.11-3.40; AOR = 2.76, 95% CI 1.58-4.83; AOR = 3.46, 95% CI 1.56-7.66, respectively). Males and females with SUDs other than alcohol and cannabis at detention had greater odds of having an SUD 15 years later, compared with those without an SUD at detention (males: 36% vs. 14%, AOR = 2.98, 95% CI 1.14-7.83; females: 29% vs. 8%, AOR = 4.77, 95% CI 1.85-12.30). Among youth with an SUD at detention, males were more likely than females to have an SUD 15 years later (AOR = 1.84, 95% CI 1.03-3.29); non-Hispanic White and Hispanic males were more likely to persist than Black males (AOR = 3.32, 95% CI 1.50-7.35; AOR = 2.32, 95% CI 1.04-5.18, respectively). DISCUSSION: The type of SUD during adolescence matters. Youth with SUDs such as cocaine and opioids fared the worst. Healthcare providers must collaborate with correctional officials to increase service provision.
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Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.
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Psiquiatria do Adolescente , Psiquiatria Infantil , Papel do Médico , Humanos , Adolescente , Psiquiatria do Adolescente/legislação & jurisprudência , Psiquiatria Infantil/legislação & jurisprudência , Criança , PsiquiatrasRESUMO
Objectives: Study objectives were to (a) understand juvenile justice staff members' experiences with engaging families in youth substance use services and (b) identify staff-perceived barriers to family engagement across steps of substance use service provision. Background: Lack of family involvement in juvenile justice system substance use (SU) services is a key barrier to successful treatment of justice-involved youth. Method: From June through November 2015, 33 focus groups were conducted at juvenile justice system probation sites across seven states. There were 263 participants, which included juvenile justice probation and behavioral health staff. Results: Strategies to engage families in services were highly variable across the 33 juvenile justice sites. Juvenile justice staff members identified barriers to family engagement in SU services including family discomfort, distrust of juvenile justice staff, lack of family service compliance, difficulties accessing SU services, lack of transportation, insurance and cost barriers, low perceived need for treatment, lack of SU education, and SU treatment stigma. Conclusion and Implications: Barriers to family engagement directly impact the success of SU service provision in juvenile justice settings. Implementation of strategies to engage families of justice-involved youth (e.g., providing tangible, informational, and emotional support to families, and involving families in juvenile justice policy and care decisions) are critical to improving SU outcomes among this vulnerable population.
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Mental health concerns among juvenile-justice-involved youth (JJIY) continue to be a major health crisis in the United States (US). While scholarship has explored mental health concerns among JJIY, and the link to negative life outcomes, there are gaps in the existing research, particularly in effective interventions and models aimed at addressing both the mental health concerns and criminogenic risk contributing to recidivism and other negative life outcomes of this population. In this paper, we present Justice-Based Interdisciplinary Collective Care (JBICC), an innovative framework to address both the mental health needs and delinquent behavior of youth offenders. The model bridges community partners, with the purpose of informing future interventions, implementations, and research in this area. Increased justice-based interdisciplinary collective collaboration between the juvenile justice system and community programs/organizations would be a major benefit to youth offenders and their families. We also focus on the need for cultural responsiveness to be interwoven throughout all aspects of treatment. JBICC offers an opportunity to expanded services outside traditional settings and methods to ensure that youth offenders and their families receive validating and culturally responsive access to services.
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Delinquência Juvenil , Humanos , Delinquência Juvenil/reabilitação , Delinquência Juvenil/psicologia , Adolescente , Estados Unidos , Direito Penal , Criminosos/psicologia , Masculino , Serviços Comunitários de Saúde MentalRESUMO
Study Objectives: Little is known about sleep health among staff in the US juvenile justice system. Poor sleep health is associated with negative mental and physical health, which may impact daily interactions and treatment of detained youth. The current study explored sleep-wake patterns and sleep health knowledge of Department of Juvenile Services (DJS) staff in Maryland (MD). Methods: DJS Staff (N = 218) were invited to complete a survey that queried staff on their own sleep-wake patterns, job role and schedule, and knowledge of youth sleep needs. Descriptive analyses and multivariate analyses of variance (MANCOVA) were conducted to summarize workers' sleep-wake patterns and examine differences by staff position and schedule. Results: Fifty-one percent of staff served as RAs who directly supervise the youth. Just over half (55%) worked in detention and 45% in treatment facilities. Staff reported sleeping 7.24 hours (SDâ =â 4.10) on workdays and 8.59 hours (SDâ =â 2.69) on non-workdays. RA staff working night/rotating versus day shifts reported the most sleep irregularity with larger weekend oversleep times. A little more than half of the staff (53.9%) were knowledgeable regarding youth sleep health with differences by position type. Conclusions: Findings show that DJS staff are meeting recommended sleep duration guidelines but are still experiencing sleep schedule and time in bed irregularity. Knowledge variability of youth sleep health across staff may necessitate focused educational programming. Overall, this study may inform future development and prioritization of sleep and circadian health interventions and educational campaigns for staff who work with detained juveniles. This paper is part of the Sleep and Circadian Health in the Justice System Collection.
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This is the protocol for a Campbell Collaboration systematic review. Our objective is to synthesize what is known about the effectiveness of strategies for reducing community violence, focusing on those strategies that have been subjected to a systematic review. We aim to answer the following questions in this review: what strategies to reduce community violence have been rigorously evaluated through systematic reviews; which have sufficient evidence of effectiveness, which seem promising, and which appear ineffective; and what implications for practice and policy can be drawn from this large body of research? We anticipate categorizing the results of our review similarly to the original review by Abt and Winship (2016). That is, categorizing reviews by people-based approaches, place-based approaches, and behavior-based approaches. However, given that this is an updated review and we will be incorporating additional studies, we may find that an alternative or additional categorization is warranted and update our categorization accordingly. Implications for policy and practice as they relate to these categories will be discussed.
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The global COVID-19 pandemic illustrates the importance of a close partnership between public health and juvenile justice systems when responding to communicable diseases. Many setting-specific obstacles must be navigated to respond effectively to limit disease transmission and negative health outcomes while maintaining necessary services for youth in confinement facilities. The response requires multidisciplinary expertise and collaboration to address unique considerations. Public health mitigation strategies must balance the risk for disease against the negative effects of restrictions. Key aspects of the COVID-19 response in the juvenile justice system of Colorado, USA, involved establishing robust communication and data reporting infrastructures, building a multidisciplinary response team, adapting existing infection prevention guidelines, and focusing on a whole-person health approach to infection prevention. We examine lessons learned and offer recommendations on pandemic emergency response planning and managing a statewide public health emergency in youth confinement settings that ensure ongoing readiness.
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COVID-19 , Adolescente , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Pandemias/prevenção & controle , Colorado/epidemiologia , Saúde Pública , Análise de SistemasRESUMO
We reviewed data obtained in October 2021-May 2023 from youth who reported a history of sexual activity upon admission to 1 of 12 juvenile justice facilities in Utah, USA, that offered screening for Chlamydia trachomatis and Neisseria gonorrhoeae. Urinalysis revealed C. trachomatis positivity of 10.77%, N. gonorrhoeae positivity of 1.08%, and coinfection C. trachomatis N. gonorrhoeae) of 0.90%. Prevalence of infection was similar for youths in rural and urban facilities. A total of 12.01% of those identifying as male and 14.01% of those identifying as female tested positive for C. trachomatis, N. gonorrhoeae, or coinfection. Of young adults who tested positive, 74.65% received their results while incarcerated, all of whom accepted treatment. Our research underscores the feasibility of providing prompt C. trachomatis/N. gonorrhoeae screening and treatment in juvenile correctional facilities. The pervasiveness of infection emphasizes the urgent need for early identification and treatment for C. trachomatis and N. gonorrhoeae in incarcerated youth nationwide.
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Infecções por Chlamydia , Coinfecção , Gonorreia , Adulto Jovem , Adolescente , Masculino , Feminino , Humanos , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Gonorreia/prevenção & controle , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Utah/epidemiologia , Coinfecção/epidemiologia , Neisseria gonorrhoeae , Chlamydia trachomatis , Estabelecimentos Correcionais , Prevalência , Programas de Rastreamento/métodosRESUMO
The care of adolescents in reclusion has been a field of work for occupational therapists in different parts of the world. The objective of this study was to describe and analyze Brazilian occupational therapists' practices with adolescents in reclusion. Research conducted in Brazil, identifying 56 professionals, invited to answer a questionnaire (n = 43); participate in discussion groups (n = 9); and interview (n = 4). Professionals reported different visions that guide their practices, including the identification of individual skills and the profession's possibilities for social action. Occupational therapists have specificities to work in these institutions, highlighting the possibilities of acting with a focus on social change. Practices in occupational therapy can lead to social change if focused on social issues. Social occupational therapy offers theoretical and methodological elements that inform the profession. Reflections on the practice carried out, according to a critical perspective, enable a performance in occupational therapy that intends social change.
OBJECTIVE: The objective was to describe and analyze the practice of occupational therapists in custodial units of the Brazilian juvenile justice system. METHODOLOGY: Mapping and identification of occupational therapists in institutions of juvenile incarceration; questionnaire; workshops; semi-structured interviews; and synthesis meeting. RESULTS AND DISCUSSION: Forty-three professionals with diverse practices participated in this study. The collected data in the different stages of the research were analyzed based on social occupational therapy. CONCLUSION: Occupational therapy practices can lead to social change if focused on social issues. Social occupational therapy offers theoretical and methodological elements for that.
Occupational Therapy and Imprisoned Adolescents: An Analysis of Professional PracticesIntroduction: In Brazil, the number of adolescents convicted of infractions is increasing. Judicial sanctions may be imposed on this population, including imprisonment. There are occupational therapists working with these adolescents, but their practices are little recorded and debated.
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'Swatantra-Clinic' at NIMHANS, India, provides mental healthcare to vulnerable children. This study describes the clinical profile, vulnerability and protective factors of 77 adolescents in conflict with the law (CICL). 90.9â¯% (n=70) reported Adverse Childhood Experiences (ACEs), 58.4â¯% (n=45) had school-related difficulties, 68.9â¯% (n=53) reported child labour experiences, 64.9â¯% (n=50) had deviant peer associations, and 40â¯% (n=31) experimented with substance use. Despite vulnerabilities, 72.7â¯%(n=56) had a positive future orientation, 45.5â¯% (n=35) had supportive caregivers and exhibited prosocial skills. only 12â¯% (n=9) followed up on recommendations, highlighting the need for collaborative and transdisciplinary care to promote CICL rehabilitation and community integration.
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Serviços de Saúde Mental , Centros de Atenção Terciária , Humanos , Índia , Masculino , Feminino , Adolescente , Serviços de Saúde Mental/legislação & jurisprudência , Criança , Populações Vulneráveis/legislação & jurisprudênciaRESUMO
BACKGROUND: Given high rates of substance use among justice-involved youth, justice systems have attempted to monitor use through drug screening (DS) procedures. However, there is discretion in deciding who is screened for substance use, as not every youth who encounters the system is screened. The aim of the current study was to examine factors associated with selection for and results of oral DS among justice-involved youth assigned to probation to better inform potential DS policy. Electronic court records from 4,668 youth with first-incident records assigned to probation in a midwestern urban county's juvenile justice system between 2011 and 2016 were included in the analytical sample. Race/ethnicity, gender, age, number of charges and charge type for the current incident were included as independent variables. RESULTS: Multivariable hierarchical logistic regression analyses indicated that males were more likely to be assigned to DS (aOR = 0.40, 95%CI [0.34, 0.46]), and more likely to test positive for use (aOR = 0.43, 95% CI [0.34, 0.54]) than females. As age increased, youth were less likely to be assigned to DS (aOR = 0.91, 95% CI [0.87, 0.94]), with non-significant differences in DS results. Greater number of charges were associated with a higher likelihood of being assigned to DS (aOR = 1.55, 95% CI [1.43, 1.68]). Youth with violent offenses were more likely to be assigned to DS than those with other offense types (property offenses, drug offenses, statutory offenses, disorderly conduct, and all other offenses), but less likely to test positive for use. CONCLUSIONS: Many factors were associated with differences in DS, but these factors were not always associated with differential DS results. Demographic or charge-based decisions may not be appropriate for DS assignment.
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Background: Trans people are incarcerated at disproportionately high rates relative to cisgender people and are at increased risk of negative experiences while incarcerated, including poor mental health, violence, sexual abuse, dismissal of self-identity, including poor access to healthcare. Aims: This scoping review sought to identify what is known about the knowledge, attitudes, and behaviors of correctional staff toward incarcerated trans people within the adult and juvenile justice systems. Method: This scoping review was conducted in accordance with the five-stage iterative process developed by Arksey and O'Malley (2005), utilizing the PRISMA guidelines and checklist for scoping reviews and included an appraisal of included papers. A range of databases and grey literature was included. Literature was assessed against predetermined inclusion and exclusion criteria, with included studies written in English, online full text availability, and reported data relevant to the research question. Results: Seven studies were included with four using qualitative methodologies, one quantitative, and two studies employing a mixed methods approach. These studies provided insights into the systemic lack of knowledge and experience of correctional staff working with trans people, including staff reporting trans issues are not a carceral concern, and carceral settings not offering trans-affirming training to their staff. Within a reform-based approach these findings could be interpreted as passive ignorance and oversights stressing the importance of organizational policies and leadership needing to set standards for promoting the health and wellbeing of incarcerated trans persons. Conclusions: From a transformational lens, findings from this study highlight the urgent need to address the underlying structural, systemic, and organizational factors that impact upon the knowledge, attitudes, and behaviors staff have and hold in correctional, and other health and community settings to meaningfully and sustainably improve health, wellbeing, and gender-affirming treatment and care for trans communities, including make possible alternative methods of accountability for those who do harms.
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Antisocial and illegal behavior generally declines as youth approach adulthood, but there is significant individual variation in the timing of the peak and decline of offending from adolescence to young adulthood. There are two primary research questions in the present study. First, are there subgroups of youth who follow similar patterns of offending over the nine years after their first arrest? Second, what baseline factors predict which youth will follow each pattern of offending? Data were drawn from the Crossroads study, which includes a sample of racially and ethnically diverse boys who were interviewed regularly for 9 years following their first arrest. Boys were between 13 and 17 years old at the start of the study and were approximately 24-25 years old at the final interview. Trajectories were measured with youths' self-reported offending using latent class growth analysis (LCGA). Results indicated that there were four subgroups of youth: a stable low group (55%), an escalating group (23%), a short-term recidivist group (15%), and a persistently high group (7%). Several baseline factors distinguished the groups. In particular, the results indicated that youth who were informally processed after their first arrest were more likely to be in the low offending group than any of the other LCGA groups. Age at first arrest, peer delinquency, exposure to violence, substance use, callous-unemotional traits, physical aggression, and perceptions of police legitimacy were also significantly related to group membership. Results suggest that certain risk factors identified after youths' first arrest may predict which youth continue to offend and which desist.