Our Research

Center for Behavioral Health and Youth Justice

Our Research

Our research has four main areas of focus:

  1. Documenting the prevalence of mental health and substance use disorders and uptake of behavioral health services among youth involved in the juvenile justice system.
  2. Using ecological approaches to understand multi-level influences on mental health and substance use disorders, and disparities in service use among youth involved in the justice system.
  3. Developing multi-level interventions to reduce risk behaviors, promote resilience and increase equity in behavioral health service access and use.
  4. Drawing on implementation science to develop and evaluate sustainable, effective, and appropriate best practices to promote cross-system collaboration between justice and behavioral health to increase access and service uptake among youth involved in the justice system.


Systems-level interventions to promote behavioral health service linkage

Project Connect
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

Family Connect
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.

The Center is currently working on e-Connect. e-Connect (R01-MH113599, PI Wasserman) builds upon our previous work on Project Connect and JJ-TRIALS. Compared to youth in the general population, those involved in the juvenile justice system are at increased risk for suicidal behavior. Youth in the juvenile justice system have increased prevalence of mood and substance use disorders, exposure to trauma, and access to suicide means (e.g. firearms, illegal substances). Additionally, evidence-based screening for youth with suicidal behavior and behavioral health concerns does not happen frequently or systematically within probation settings. Consequently, youth who do meet criteria for a mental health disorder are often not referred for treatment, and even fewer access care. The aims of this research project are to create a more effective way to identify youth suicide risk in probation settings, and to link the identified youths more efficiently to behavioral health care. In order to address service gaps in the identification of suicide risk for youth in contact with the juvenile justice system, e-Connect relies on universal application of an evidence-based screening tool during the intake process, and subsequent systematized referral and linkage to care in the mental health and substance use service sector. We will address this by: 1) training probation staff to increase their understanding on youth suicide risk and their correlated behavioral health needs; 2) utilizing an existing evidence-based screen for suicidal behavior and behavioral health needs; and 3) developing a mobile application to integrate the screening, classification of clinical need, and development of a related county-specific referral plan. We are currently in the development phase for this project, and we will begin collecting baseline data in October 2018. Our e-Connect protocol will be rolled out in three waves across ten counties in New York state beginning May 2019.

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.

Prevalence of mental health and substance use disorder among youth in the juvenile justice system

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. >>See Related Publications

Contribution of disorders to recidivism

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