Center for the Promotion of Mental Health in Juvenile Justice
Our research has four main areas of focus:
- Systems-level interventions to promote behavioral health service linkage;
- Identifying what works in promoting best practices for community juvenile justice agencies and their behavioral health partners;
- Prevalence of mental health and substance use disorder among youth in the juvenile justice system;
- Contribution of disorders to recidivism;
To address difficulties faced by community juvenile justice agencies in identifying youth service needs (particularly behavioral health and suicidal behavior), and in linking identified youths to community care, we developed Project Connect, a service-system intervention. Supported by a Garrett Lee Smith Suicide Prevention grant from SAMHSA, we worked with four New York State counties (Albany, Broome, Onondaga, and Orange) from June 2006 to November 2007. Our efforts were aimed at reducing suicide risk for juvenile probationers. We found that the combined use of (1) systemic screening for suicidality, (2) cross-agency decision trees about service linkage, (3) cross-agency Memorandums of Understanding (MOUs), and (4) behavioral health training increased access to services for identified youth by a factor of three. >>See Related Publications
Dr. Elkington’s work on Family Connect addresses issues related to lack of family engagement and follow-through as a barrier to youth service access. This innovative service delivery model targets families, integrating cross-system linkage protocols from Project Connect with adapted evidence-based family engagement strategies. This approach is delivered by a linkage specialist (patient navigator) to improve engagement, linkage, and retention of probation youth by behavioral health services. Pilot testing of this intervention is ongoing.
Identifying what works in promoting best practices for community juvenile justice agencies and their behavioral health partners
Our center is part of a multi-site cooperative research initiative of the National Institute of Drug Abuse. Known as the Translational Research on Interventions for Adolescents in the Legal System Research Collaborative (JJ-TRIALS), the group’s primary objective is to promote the systematic use of evidence-based practices to address the challenges faced by justice professionals when linking juvenile probationers to behavioral health services. In New York, we are working with the Office of Probation and Correctional Alternatives in six counties (Nassau, Niagara, Onondaga, Orange, Rensselaer, and Schenectady). Activities focus on promoting increased service access for community probationers, and evaluating the degree of implementation support that community agencies need to effect meaningful change. >>See Related Publications
Our work with JJ-TRIALS, Project Connect, and Family Connect is informed by our center's previous research described in the sections below.
When we began our work on prevalence, both researchers and clinicians were limited in their efforts by a lack of clarity regarding the rates of disorder in the juvenile justice population, the characteristics associated with disorder, and the consequences of disorder for these youths. As an innovative approach to addressing these questions, we implemented the use of the Voiced Version of the Diagnostic Interview Schedule for Children (V-DISC) across a wide range of state and local juvenile justice agencies. Because of its voiced, self-assessment format, the V-DISC was well-suited, both for agencies wishing to screen for disorder, and for our own research interests in the epidemiology of disorder in these youths. Based on our research program spanning more than 15 years, we provided instrument support, training, and prevalence reports to 57 juvenile justice sites in 17 states. These efforts resulted in over 25 scholarly publications based on the national archive for 9,819 youths.
Our work has examined the degree to which the mental health disorder profiles of adolescents in the system predicted subsequent arrests as juveniles and later, as young adults. We found that baseline externalizing disorders in these youth were associated with increased recidivism risk for both genders, whereas anxiety disorders were not associated with recidivism. Girls with comorbid substance use and affective disorder were nearly four times more likely to reoffend than girls with no disorder. In contrast, among boys, this disorder profile was associated with approximately half the level of recidivism risk. These results support practice guidelines recommending comprehensive mental health assessment in juvenile justice settings for youths with certain mental health symptoms, who might be well-served by diversion programs. Our data also show that juveniles with a substance use disorder (with or without co-occurring disorders) were at greater risk for escalations in offense seriousness over time. Early in juvenile justice system contact, juveniles should get effective treatment for substance use to prevent offending escalation. Finally, our works supports the premise that mental health diversion can be used effectively to delay or prevent youth recidivism. >>See Related Publications