1. The Relationship between Mental Health
Indicators and Adjudication Rates Among Youth
with Serious Emotional Disturbance
Michele Ybarra, M.P.H.1
Christine Walrath, Ph.D.2
Wayne Holden, Ph.D. 2
Rolando Santiago, Ph.D. 3
Phil Leaf, Ph.D. 1
Johns Hopkins Bloomberg School of Public Health
2
ORC MACRO
3
Child, Adolescent and Family Branch - Center for Mental Health Services
1
International Association of Forensic Mental Health Services Annual
Conference, April 2003, Miami FL
* Thank you for your interest in this presentation.
Please note that analyses included herein are
preliminary. More recent, finalized analyses may be
available by contacting CiPHR for further information.

2. Juvenile Justice Involvement and
Mental Health
 An estimated 2.5 million juvenile
arrests were reported in 1999 (Shelton, 2001).
 Youth involved with the juvenile justice
system have high rates of mental
disorder (Shelton, 2001; McManus, Alessi, Grapentine &
Brickman, 1984; Wierson, Forehand & Frame, 1992; Teplin, Abram,
McClelland, Dulcan, & Mericle, 2002).

3. Youth with Prior Justice Involvement
Currently Receiving Services
 20% of youth in the public mental health
system have a history of juvenile arrest
(Rosenblatt, Rosenblatt & Biggs, 2000; Vander Stoep, Evens, & Taub, 1997; Breda,
1995).
 Compared to youth receiving mental health
services without prior justice involvement,
dually-involved youth are: (Rosenblatt, Rosenblatt & Biggs,
2000; Bryant et al., 1994)


more likely to be diagnosed with substance abuse and
behavior disorders (e.g., conduct disorder).
less likely to be diagnosed with an anxiety disorder.

4. Study Rationale


Similar studies to date have focused on regional
samples.
The unique characteristics of justice-involved
youth provide critical information to the
individualized service planning process,
therefore
 we must investigate mental health challenges faced by
dually involved youth and how they differ from other servicereferred youth.
This study compares the rate of prior adjudication of
service-referred youth as a function of the presence
versus absence of specific mental health challenge
indicators.

5. Study Methodology

Data were collected by communities funded in 1993
and 1994 (22 sites) as part of the national evaluation of
the Comprehensive Community Mental Health Services
for Children and Their Families Program.

Sample Selection Criteria:
1)
2)
3)
Youth participating in the child and family outcome study of
the national evaluation (of a possible 18,906).
10 years of age or older
Complete data on 7 study variables.
2,662 who had complete data ⇒ Study Sample
Study sample contained slightly more Caucasian youth and youth of ‘other’ races.

6. Measures and Indicators
Demographic
characteristics
Age
Gender
Race/ethnicity
Household income
Mental health
indicators
Global Assessment of Functioning
Primary Axis I diagnosis
Presenting problem(s)
History of
delinquency
Prior adjudicated misdemeanor
Prior adjudicated felony

7. History of Adjudication by Gender
(N=2,662)
Males with > = 1
prior adjudication
14%
Males with no
prior adjudication
49%
Females with no
prior adjuication
31%
Females with > = 1
prior adjudication
6%

8. History of Adjudication by
Race/Ethnicity N=2,662
Percentage of Youth in Sample
70%
60%
65%
No prior adjudciation
58%
> =1 prior adjudication
50%
40%
30%
21%
20%
8% 10%
10%
12%
15%
11%
0%
White
Black
Hispanic
Race/Ethnicity
Other

9. History of Adjudication by Age
N=2,662
No prior adjudciation
>=1 prior adjudication
Percentage of Youth in Sample
30%
25%
24%
20%
15%
18%
13%
14%
14%
10%
12%
14%
15%
14%
10%
5%
0%
15%
19%
4%
5%
5%
2%
10
11
12
13
14
Age (years)
15
16
17

10. Prevalence of Psychiatric Disorder by
(N=2,662)
Adjudication History
Percentage of Youth in Sample
adjusted for race/ethnicity, household income, and gender
60%
No Adjudications
>=1 adjudication
52%
50%
40%
32%
30%
23% 21%
20%
20%
11%
10%
9%
4%
1%
0%
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11. Analytic Approach

Poisson for count data used to calculate
the relative rates of adjudication as a
function of multiple indicators of mental
health (adjusted for gender,
race/ethnicity, household income):



Global Assessment of Functioning (lowest 16%
of sample versus higher)
Primary Axis I Diagnosis
Reason for Referral to Services

12. Analytic Approach (cont.)

Comparisons of youth by adjudication
history and primary diagnosis

χ2 tests for differences across the four groups


Prior adjudication w/o CD / SRD

No prior adjudication w/ CD / SRD


Prior adjudication w/ CD / Substance-Related Disorder (SRD)
No prior adjudication w/o CD / SRD
Comparison of demographic characteristics

13. Relative Rates of Prior Adjudication as a
Function of Primary Psychiatric Diagnosis
(N=2,662)
adjusted for race/ethnicity, household income, and gender
3.5
Relative Rate of Adjudications
3.09
***
3
2.5
Conduct Disorder
Substance Related Disorder
Depression/Dysthymia
ADHD
Anxiety
2.08***
2
1.5
1.7***
1.25*
1.23
1
*
0.85
0.5
0
0.62***
0.65 **
0.45***
Misdemeanor(s)
Felony(s)
Adjudication Type
***p<.001; **p<.01; * p<.05
0.21
***

14. Relative Rates of Prior Adjudication as a
Function of Global Functioning (N=2,662)
adjusted for race/ethnicity, household income, and gender
Relative Rate of Adjudications
1.4
1.34 **
1.3
1.2
*
1.16
1.1
1
Misdemeanor(s)
Felony(s)
Adjudication Type
**p<.01; * p<.05

15. Relative Rates of Prior Adjudication as a
Function of Reason for Referral into Services
(N=2,662)
adjusted for race/ethnicity, household income, and gender
Delinqueuncy-Related
Conduct-Related
Suicide
Hyperactivity
Adjustement-Related
Depressed Mood
Relative Rate of Adjudications
3.5
3.0
3.00 ***
2.5
2.0
1.5
1.76***
1.22 ***
1.0
0.5
0.0
0.75** 0.67
*** 0.61
***
Misdemeanor(s)
0.76** 0.78
***
0.51
Adjudication Type
Felony(s)
***p<.001; **p<.01; * p<.05
0.73**
0.88
0.93

16. Putting it all Together: Relative Rates of Adjudication
Mental Health Indicator
Misdemeanor(s) Felony(s)
Primary Psychiatric Diagnosis
Conduct Disorder
>
Substance Related Disorder
>
>
Depression/dysthymia
<
>
ADHD
<
<
Anxiety
<
<
Delinquency-Related
>
>
Conduct-Related
>
<
Suicide
<
Hyperactivity
<
Adjustment-Related
<
Depressed Mood
<
Reason for Referral
Global Assessment of Functioning
>
<
>

17. Comparisons of Youth by Adjudication
History and Primary Diagnosis
(N=2,662)
Percentage of Youth in Sample
60%
53%
50%
Conduct or Substance-Related Disorder
40%
No Conduct or Substance-Related Disorder
27%
30%
20%
10%
11%
9%
0%
>=1
None
Ajudication History

18. Age as a Function of Four Groups of
Adjudication-Primary Diagnosis (N=2,662)
15.0
14.7
14.8
Prior Adjudication w/o CD/SRD
Prior Adjudication w CD/SRD
Mean Age (years)***
14.5
No Prior Adjudication w/o CD/SRD
No Prior Adjudication w CD/SRD
14.0
13.5
13.0
13.3
13.0
12.5
12.0
Adjudciation-Primary Diagnosis Category
*** F=34.8; p<.001

19. Percent of Youth within Adjudication-Primary
Diagnosis Category
Gender as a Function of Four Groups of
Adjudication-Primary Diagnosis (N=2,662)
72%
70%
70%
68%
Prior Adjudication w/o CD/SRD
Prior Adjudication w CD/SRD
68%
No Prior Adjudication w/o CD/SRD
No Prior Adjudication w CD/SRD
66%
63%
64%
62%
60%
60%
58%
56%
54%
% Male***
***χ2=16.1; p<.001

20. Percentage of Youth wihtin Adjudication-Primary
Diagnosis Category
Race/Ethnicity as a Function of Four
Groups of Adjudication-Primary
(N=2,662)
Diagnosis
80%
70%
73%
69%
50%
Prior Adjudication w/o CD/SRD
58%
60%
Prior Adjudication w CD/SRD
47%
No Prior Adjudication w/o CD/SRD
No Prior Adjudication w CD/SRD
40%
26%
30%
21%
20%
13%
11%13%
13%
6%
10%
7% 9%
14%12%
8%
0%
Non-Hispanic
White
Hispanic
Non-Hispanic
Black
Race/Ethnicity***
***χ2=110.8; p<.001
Other

21. Summary
Relative rates of adjudication history differ significantly as
a function of:
 Primary diagnosis
 conduct disorder associated with elevated rates of prior
adjudication for misdemeanor and felony adjudication
 substance abuse and depression/dysthymia associated with
elevated rates of felony adjudication
 anxiety and ADHD associated with lower rates of prior
misdemeanor and felony adjudication

Reason for referral
 elevated rates of misdemeanors adjudication associated with
referral for delinquency and conduct-related problems
 lower rates of misdemeanor adjudication associated with suicide,
hyperactivity, adjustment-related, and depressed mood

Global assessment of functioning
 elevated rates of misdemeanor and felony adjudications associated
with poor (lowest 16% of sample) functioning

22. Summary
 44%
of youth with a history of
conviction had an Axis I
diagnosis other than substance
abuse or conduct disorder
 Youth
differ in terms of
race/ethnicity, gender, and age
as a function of adjudication
history-diagnosis category.

23. Study Limitations
1.
2.
Cross sectional data
Validity of the conviction variable
•
1.
2.
Caregiver report and administrative record
Specific crime types not investigated
Collection of psychiatric diagnosis via
chart review

24. Implications

Diagnosis at time of intake into service is
significantly related to adjudication history
among youth with serious emotional
disturbance who are referred into system-ofcare services.

Youth with a primary diagnosis other than CDSRD and with a history of adjudication may vary
in demographic characteristics compared to
other youth.