Abstract
A majority of adolescents formally involved in juvenile court have at least one, if not more than one, significant emotional or learning impairment, or maltreatment experience. This is particularly true in juvenile detention and incarceration facility populations. While this problem is increasingly recognized within the juvenile justice system and social work profession, often the impact and correlation to delinquency of these child and youth difficulties is underestimated. This paper reviews the links from mental health disorders, learning (and academic-related) disabilities, and maltreatment victimizations to delinquent and serious youthful offending behaviors, and provides successful collaboration outcome examples to address this problem. The most difficult challenge to juvenile courts and youth-caring systems is working with adolescents and families with comorbid difficulties, for this group is most at risk for incarceration and involvement with the adult criminal justice system.
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Introduction
The number of adolescents nationwide referred annually to the juvenile courts is substantial: over 2.0 million arrests (Puzzanchera 2009), over 900,000 formally processed and involved (Knoll and Sickmund 2010), more than 350,000 held in detention centers (Holman and Ziedenberg 2006; Sickmund 2009) and more than 90,000 held in correctional facilities (Davis et al. 2008; Hockenberry et al. 2010). Calculated as a daily census, over 60,000 youthful offenders are being held each day in a detention or incarceration facility by order of a juvenile court (Sickmund 2009).
Of these youthful offenders who are formally involved and adjudicated delinquent (an official court order providing legal control over the youth), over 70 % are male (though the female proportion has increased over the past two decades), over 64 % are Caucasian (though a disproportionate number are minority), and ~50 % are younger than age 16 (Knoll and Sickmund 2010). When youthful offenders further penetrate the juvenile justice system and are incarcerated, the population becomes significantly more stratified. A majority of the incarcerated youthful offender population is 16- and 17-year olds, over 87 % male, and 68 % are minority. Of those incarcerated who are minorities, ~60 % are African-American, 33 % are Hispanic, and, depending on the jurisdiction, between one and 4 % is American Indian or Asian (Office of Juvenile Justice and Delinquency Prevention 2011), a phenomenon known as disproportionate minority confinement (DMC) and found in nearly all states (Piquero 2008).
This paper reviews and synthesizes three areas of social work and juvenile justice literature. First, the prevalence and impact that maltreatment victimization, learning and academic-related disabilities, and mental health problems have on delinquent and serious youthful offending behaviors, an understudied and often underappreciated phenomenon (Mears and Aron 2003; Washburn et al. 2008). Second, the problem of comorbidity across these child and adolescent difficulties and the particular risk this poses for serious offending behaviors and incarceration. And, third, the challenges of youth-caring systems collaboration to address these problems, with examples of effective coordination outcomes.
Systematic Review Method
This systematic review of the literature focused on a number of empirical questions: (1) what is the prevalence of maltreatment victimization, learning disabilities, and mental health disorders in juvenile court populations, both those delinquent and those held in detention and incarceration facilities; (2) what impact do these child and adolescent difficulties have on subsequent offending behaviors and involvement in the juvenile justice system; (3) what level of comorbidity exists across these difficulties for this population, and subsequently what impact does this have on the adolescent; and, (4) what effective efforts have occurred to address these difficulties within this at-risk adolescent population?
To answer these questions, a systematic literature review search was completed of the following databases: Social Work Abstracts, SocIndex, ERIC, Criminal Justice Abstracts, PsychInfo, and Psychology and Behavioral Sciences Collection. This search utilized the following terms, both individually and in combination with each other: mental health, disorders, special education, learning disability, substance abuse, substance use, school problem, delinquency, offenders, juvenile, detention, incarceration, maltreatment, and trauma. The results of these searches and subsequent analysis are next presented.
Links to Delinquency
Maltreatment victimization, school/education problems, and mental health disorders (including substance abuse) are associated with profound difficulties for many children and adolescents. These experiences and disabilities are often linked to later or subsequent offending and delinquent behaviors, which for some adolescents becomes an offending recidivism cycle, a negative outcome with serious repercussions. This link from child and adolescent difficulties to delinquency is most evident within the juvenile detention and incarceration facilities. Within these facilities a majority of youthful offenders have been identified with at least one of these difficulties or maltreatment experiences, though many adolescents have combinations of these problems before, during, and after release from detention or incarceration (Garland et al. 2001; Mallett 2009; Rosenblatt et al. 2000). Detention, and in particular incarceration, facilities provide a bleak backdrop for teenagers struggling to come to terms with adolescence (Holman and Ziedenberg 2006). The prevalence rates of youthful offenders within these facilities who are disproportionately minority and suffer from disability and maltreatment victimization prevalence rates is alarming, all the more so when compared to overall prevalence of these conditions among adolescents in their home communities (see Table 1).
In the general population, most children and adolescents do not suffer from nor experience any of these maltreatment victimizations, disabilities, or mental health problems. If a child or adolescent does have one of these difficulties, it most often is a singular experience, that is, only one mental health problem or one learning disability (Mallett 2003). Only a small percentage of children and adolescents will ever be diagnosed with a mental health disorder (9–18 %), have an active substance abuse problem (4–5 %), be a victim of maltreatment (<1 %), or have a special education disability (4–9 %), of which a majority of these are learning disabilities or emotional disturbances (New Freedom Commission on Mental Health 2003; Substance Abuse and Mental Health Services Administration 2008a, b; US Department of Education 2010; US Department of Health and Human Services 2010). However, for decades, reviews of detained and incarcerated youthful offenders have found significantly higher incidences of these difficulties and maltreatment victimizations within this population: from two (some mental health disorders) to as many as 60 times (for maltreatment victimization) the rates found in the adolescent population (Chassin 2008; Grisso 2008; Mears and Aron 2003; Teplin et al. 2006; Washburn et al. 2008).
A review of the higher percentages of identified problems for detained and incarcerated youthful offenders, compared to their non-detained and non-incarcerated peers, highlights the link to serious offending. Additionally, the high prevalence rates of difficulties of detained and incarcerated youthful offenders become more complex and more difficult to unravel because of frequent comorbidities. Court-involved adolescents often have multiple difficulties and/or disorders occurring both over time and at the same time, a situation that may greatly compound the negative outcomes (Dembo et al. 2008). As noted, this comorbidity conundrum is an under-investigated phenomenon, but one that may greatly affect serious and chronic offenders (Mears and Aron 2003; Washburn et al. 2008). Correlative links between maltreatment experiences, educational disabilities, and mental health disorders and subsequent offending and delinquency are explored next, along with the comorbidity of these difficulties.
Maltreatment Victimization
Child and adolescent maltreatment victimization may entail a wide range of harmful treatment: from physical, sexual, emotional, or psychological abuse to neglect. Such maltreatment has increasingly been found to evoke serious, long-lasting negative repercussions for many of the victims. Some refer to these experiences as chronic trauma, acute trauma, and/or complex trauma (Buffington et al. 2010). Broader definitions of maltreatment note that victimization over time complicates recovery, though for some children and adolescents just one instance of victimization can be sufficiently traumatic to induce symptoms (National Child Traumatic Stress Network 2008).
Over the past two decades, ~800,000–1,000,000 children and adolescents nationwide each year are victims of reported and substantiated maltreatment, the majority of which are neglect cases (ranging from 50–80 %, depending on the year), followed by physical abuse (17–27 %), sexual abuse (9–17 %), and psychological abuse (4–7 %). The victims of such maltreatment do not differ in terms of gender—males and females are equally at risk. However, they are disproportionately younger (under the age of 10, with adolescents comprising only 20 % of current victims) and minority (African-American, American Indian, and Pacific Islander) (Administration for Children and Families 2010, 2011).
Many of the adolescents involved with the juvenile courts have maltreatment histories; that is, they are past victims of physical, sexual, psychological abuse or neglect. In fact, when identifying such histories, between 26 and 60 % of formally juvenile court-involved adolescents have been found with these maltreatment histories (Bender 2009; Ford et al. 2007; Mallett and Stoddard-Dare 2009; Sedlak and McPherson 2010; Stouthamer-Loeber et al. 2002; Tuell 2002). Though maltreatment is a significant risk factor for later juvenile court involvement, it is important to highlight that a large majority of children and adolescents who are victims never become involved with the juvenile courts (Widom 2003; Yun et al. 2011). However, victims of maltreatment are significantly overrepresented among youth involved with the juvenile courts and, in particular, among youthful offenders who are detained and incarcerated (Currie and Tekin 2006; Lemmon 2006).
The correlation between maltreatment and juvenile delinquency is a serious concern. Research is gradually revealing how victimization experiences may contribute to the children’s and adolescents’ pathway into delinquency. Yet this remains a complex matter because of the differential impact of maltreatment and because a number of maltreatment outcomes are, in their own turn, also significant serious youthful offending risk factors.
From Maltreatment to Delinquency
This link was first identified in finding that maltreated youthful offenders had not only a significantly greater chance of being arrested, but also a greater likelihood of being arrested a year earlier than did non-maltreated youthful offenders (Widom 1989). Additionally, these maltreated adolescents were more likely to be formally supervised by the juvenile court for more serious offending behaviors than were their non-maltreated peers (Loeber and Farrington 2001; Smith and Thornberry 1995). All three maltreatment types (physical abuse, sexual abuse, neglect) have been linked to later antisocial behavior, violent crimes, and court involvement (Lemmon 2009; Widom and Maxfield 2001; Yun et al. 2011), even in the presence of these other risk factors (Loeber and Farrington 2001; Smith and Thornberry 1995). Research is clear that repeated maltreatment no matter the type has a key impact on youthful offending behavior. Such repeat victimization predicts the initiation, continuation, and severity of delinquent acts (Verrecchia et al. 2010), and is associated with serious, chronic, and violent offending behaviors (Hamilton et al. 2002; Smith and Thornberry 1995).
Within juvenile court populations, females are more likely than males to have been victims of sexual abuse and are equally likely to have experienced physical abuse (Hennessey et al. 2004; Shelton 2004). The cumulative impact of maltreatment, in addition to other risks often associated with this maltreatment, such as substance abuse and school difficulties, may affect females more negatively than males (Howell 2003; National Center for Child Traumatic Stress 2009). However, research findings are not sufficiently conclusive to posit that maltreatment effects for females are greater when compared to males in delinquency development (Zahn et al. 2010).
Maltreatment Outcomes and Serious Offending Risks
Another complex concern about delinquency risk factors centers on the number of maltreatment effects that are subsequently also risk factors for serious youthful offending. Children and adolescents who have been maltreated will have higher risks for certain harmful outcomes, and some of these harmful outcomes themselves are also correlated with increased risk of offending. These include mental health/substance abuse problems and school difficulties (Hawkins et al. 2000).
Mental Health and Substance Abuse Problems
Mental health and substance abuse problems are often outcomes of child and adolescent maltreatment. Repeated physical abuse of children often results in depression and post-traumatic stress disorder (Kilpatrick et al. 2003); sexual abuse is associated with post-traumatic stress disorder and other anxiety difficulties; and neglect also often leads to anxiety disorders and related problems (Turner et al. 2006). In turn, increasing evidence links these and other mental health difficulties to later youthful offending behaviors and delinquency, though such link may be direct or indirect, perhaps with interceding problems (Widom and White 1997).
School Difficulties
Children and adolescents with maltreatment victimization histories, compared to those without similar histories, are less successful in both primary and secondary school. Depending on when the maltreatment occurs, the child’s development and school performance may be differentially impacted (Leiter 2007; Veltman and Browne 2001).
Cognitive and language delays in primary school are greater for maltreated children versus non-maltreated children from lower socio-economic backgrounds, and much greater when compared to non-maltreated children from higher socio-economic backgrounds (Wiggins et al. 2007). On average, maltreated children enter school one-half year behind on academic performance (Smithgall et al. 2004) and have poorer academic performance and functioning at ages six and eight (Zolotor et al. 1999). These children also have higher absenteeism rates that may be affecting or complicating these negative outcomes (Lansford et al. 2002; Leiter 2007). An increased severity of maltreatment may also have a harmful impact on children’s verbal abilities and verbal intelligence quotient (Perez and Widom 1994). Experiencing maltreatment at an earlier age may lead to behavior problems and increased placement into special education programs (Leiter and Johnson 1997). Children in foster care are more likely to be diagnosed with a special education disability during earlier school years: between 30 and 50 &% in some populations (Frothingham et al. 2000; Goerge et al. 1992; Scarborough and McCrae 2009). Children in foster care are often behind in grade level and in reading and mathematics ability (Burley and Halpern 2001; Conger and Rebeck 2001; Hyames and de Hames 2000).
For older secondary-age adolescents, maltreatment negatively affects their academic, social, and related outcomes (Coleman 2004). Older adolescents, particularly those with longer histories of maltreatment victimization, are often three or four grade levels behind in reading abilities and repeat at least one grade significantly more often than non-maltreated adolescents, making their chances of high school completion much less likely (Slade and Wissow 2007). Similarly, adolescents who have experienced foster care placement are particularly at risk, with a much higher percentage not completing high school compared to their non-maltreated peers (Courtney et al. 2004). Adolescents with maltreatment histories who do not complete high school, those in foster care who are truant or change schools often, and those aging out of the child welfare system are at high risk for becoming involved in offending and delinquent activities. Without effective supports or efforts to complete their secondary school education, as young adults this group typically finds that their employment and independent living options are limited (Lederman et al. 2004; Lipsey and Derzon 1999; Ryan et al. 2007).
Special Education Disabilities
Special education disabilities include a wide range of physical, education, and emotional impairments, including mental retardation (developmental delays), deafness and other hearing impairments, blindness, autism (spectrum), speech and language problems, orthopedic problems, traumatic brain injury, emotional disturbances, and specific learning disabilities. Adolescents with special education disabilities are not common in the general population, accounting for at most 9 % of school-aged children and adolescents (ages 6–21). The most common of these education-related disabilities is a specific learning disability, affecting 4 % of school-aged children and adolescents (ages 6–21). Because learning disabilities are often not remedied, older adolescent populations account for a larger percentage of the total population of children and adolescents with learning disabilities. Among older adolescents, learning disabilities account for a higher percentage of all special education disabilities: 14 % for youth ages 6–11, but 26 % for youth ages 12–17 (US Department of Education 2009, 2010).
The incidence of adolescents with special education disabilities is much higher among juvenile court populations, particularly in detention and incarceration facilities, than in the population overall. It is estimated that between 28 and 43 % of detained and incarcerated youthful offenders have an identified special education disability (Kvarfordt et al. 2005; National Center on Education, Disability, and Juvenile Justice 2001; Rozalski et al. 2008; Wang et al. 2005; White and Loeber 2008). Among youthful offenders with special education disabilities within incarceration and detention facilities, 48 % had an identified emotional disturbance, 39 % had a specific learning disability, 10 % had mental retardation, and 3 % had other health impairments (Quinn et al. 2005). Incidences for incarcerated youthful offenders have not changed significantly over time (Rutherford et al. 1985). The two most common special education disabilities are of primary concern here because they are most prevalent in detention and incarceration facility populations—specific learning disabilities and emotional disturbances (Burrell and Warboys 2000; Mallett 2011).
Learning Disabilities and Emotional Disturbances
A lack of consistent definitions across systems that address some of the special education disability impairments of at-risk children and adolescents further complicates an already difficult situation. For instance, within school systems and in special education disability laws mental health problems are defined as “emotional disturbances,” rather than a diagnoses or specific disorders recognized within the youth mental health sector (American Psychiatric Association 2000). When a child or adolescent is identified within school special education departments as having an emotional disturbance, for all practical and intervention purposes, this is equivalent to a mental health diagnosis, a more serious and impairing problem than many disorders, such as some behavioral or anxiety difficulties. However, emotional disturbances significantly impair the functioning of children and adolescents, both at home and in school. Presumably at some point these children and adolescents will be identified by the youth mental health system as having ongoing difficulties comorbid with mental health disorders (Reddy 2001; Theodore et al. 2004). In fact, this small subset of children and adolescents with such emotional disturbances are the most likely to fail in school and least likely to complete high school (New Freedom Commission on Mental Health 2003; Reddy and Richardson 2006). As with children and adolescents who have experienced maltreatment, those with learning disabilities, mental health and emotional problems, and issues related to those conditions, have an increased risk of delinquency as well.
A learning disability is defined by federal law as “a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations” (Code of Federal Regulations 2011). Learning disabilities vary in impact across children and adolescents, are diagnosed on a continuum from mild to severe, and can appear differently in various academic or nonacademic settings (Council for Learning Disabilities 2011). Of interest and concern, because of the linkage of these disabilities with juvenile court populations, is that certain minority adolescents are at higher risk for learning disabilities: Hispanics are almost 20 % more likely; African-Americans more than 40 % more likely; and American-Indians more than 80 % more likely (US Department of Education 2010). There are often risk factors that are comorbid between and among these disabilities. Risk factors that increase the likelihood of having a learning disability include living in poverty, male gender, poor family functioning, being adopted, and lower household education attainment; these are also risk factors for juvenile delinquency (Altarac and Saroha 2007).
From Learning Disabilities to Delinquency
Children at risk for academic failure in elementary school often have unidentified special education and learning disability needs, and are subsequently at increased risk for later violent behaviors (Hawkins et al. 2000). More broadly, adolescents with unidentified learning disabilities may be disproportionately represented among those who are suspended, expelled, and/or drop out of high school (Keleher 2000). Suspensions, expulsions, and drop-outs are all risk factors for delinquent offending activities, often serious offending (Hawkins et al. 2000; Sum et al. 2009).
Reviews have found that adolescents with learning disabilities, compared to those adolescents without such learning disabilities, have two to three times greater risk of being involved in offending activities (Matta-Oshima et al. 2010; Wang et al. 2005), as well as higher recidivism rates (Katsiyannis and Archwamety 1997). Adolescents with learning disabilities were found to be at an increased risk of being arrested while in school, as well as within one year after they finished school (Doren et al. 1996). However, this link has not been consistently identified within delinquent populations, nor does it always serve as a precursor to delinquent activities, calling for continued investigations (Malmgren et al. 1999; White and Loeber 2008). Still and all, this link from the schools to the juvenile courts, as well as to detention and incarceration facilities, has gained the attention and concern of many policy makers and stakeholders. This pathway, often called the school-to-prison pipeline, may be funneling adolescents with learning disabilities in disproportionate numbers into the juvenile justice system (Federal Advisory Committee on Juvenile Justice 2010).
Mental Health and Substance Abuse Disorders
Most of the children and adolescents in the general population with an identified mental health or substance use problem are considered to have mild or moderate impairments (Kessler et al. 2005; Substance Abuse and Mental Health Services Administration 2008a). A smaller subset of this population, between 5 and 10 %, develop serious emotional disturbances that cause substantial impairment in functioning at home, at school, and/or in the community. This group of children and adolescents with serious emotional disturbances do not differ significantly in terms of age, ethnicity, or gender from the general youth population (Substance Abuse and Mental Health Services Administration 2008b). However, these severely impaired adolescents have challenges accessing mental health services, have trouble in school settings, and are often formally involved with the juvenile courts (Armstrong et al. 2003; Bazelon Center for Mental Health Law 2003; Simpson et al. 2005). In fact, this small group of adolescents who are considered seriously emotionally disturbed typically have long histories of multiple mental health disorders that will normally persist into adulthood, and make up an estimated 15–20 % of the youthful offenders in juvenile justice detention and incarceration facilities (Cocozza and Skowyra 2000; MacKinnon-Lewis et al. 2002).
Detention and Incarceration Facilities
Mental health disorders are much more common within detention and incarceration facilities than in the general adolescent population. Common mental health disorders found within youthful offender correctional facility populations includes depressive disorders (between 13 and 40 %), psychotic disorders (between 5 and 10 %), anxiety disorders (up to 25 %), attention-deficit hyperactivity disorder (ADHD) (up to 20 %), disruptive behavior disorders (between 30 and 80 %), and substance use disorders (between 30 and 70 %) (Abram et al. 2003; Kinscherff 2012; Goldstein et al. 2005; Shufelt and Cocozza 2006). Gender and race differences appear across these disorders for this population.
Females are at higher risk than males for mental health difficulties, with up to two-thirds of males and three-quarters of females meeting criteria for at least one mental health disorder (Huizinga et al. 2000; Teplin et al. 2002; Wasserman et al. 2002). Both conduct disorder and ADHD are prevalent in delinquent male populations (Moffitt et al. 2001); while depression, anxiety, and post-traumatic stress disorder, often related to maltreatment victimization, are prevalent in delinquent female populations (Teplin et al. 2002). Over 29 % of females compared to 11 % of males in detention and correctional facilities were diagnosed with major depression; however, equal rates of conduct disorder, over 50 %, were found for both males and females (Fazel et al. 2008). A unique review of youthful offenders entering the juvenile courts at intake found what may be expected, in light of other epidemiology literature: lower rates of mental health disorders for youth entering the juvenile courts compared to incarcerated youth; higher rates for youth entering the juvenile courts compared to the general population; and females reporting higher rates of mental health problems than males in most categories (McReynolds et al. 2008).
Prevalence and patterns of mental health and substance disorders also appear to differ across race in populations of incarcerated youthful offenders. Caucasian youthful offenders, in one location, met criteria more often for a mental health disorder than either Hispanic or African-American youthful offenders (Teplin et al. 2002). In addition, female Caucasian youthful offenders were most likely to report a problem and African-American youthful offenders, either gender, least likely to report a problem (Cauffman 2004; Vaughn et al. 2008; Wasserman et al. 2005).
From Mental Health Problems to Delinquency
Mental health difficulties and disorders are linked to later youthful offending behaviors and delinquency adjudication, though it is not clear if this link is direct or if these difficulties lead to other risk factors, poor decision-making, or the interaction of various other risks (Grisso 2008; Mallett 2009; Mallett and Stoddard-Dare 2009; Moffitt and Scott 2008; Shufelt and Cocozza 2006). Still, reviews have consistently found that children and adolescents who are involved with mental health services have a significantly higher risk for later juvenile court involvement (Rosenblatt et al. 2000; Vander-Stoep et al. 1997).
In reviews that investigated the link from specific childhood mental health difficulties to juvenile court involvement a number of pathways have been established. Developmental studies have found behavioral and emotional problems to be predictive of later delinquency and substance abuse. Early childhood aggressive behaviors have been found predictive of later delinquent behaviors and activities. Attention and hyperactivity problems are linked to later high-risk taking and more violent offending behavior. In addition, childhood depression and ADHD have been found linked to later delinquency, evidenced through physical aggression and stealing behaviors (Grisso 2008; Hawkins et al. 2000; Wasserman et al. 2003).
For adolescents who are detained or incarcerated, a number of pathways from earlier mental health problems have been identified. Adolescent mental health and delinquent populations were found to be at higher risk for detention or incarceration with a diagnosis of alcohol problems or conduct disorder in middle school, reported use and abuse of substances, and being African-American or Hispanic—a potential tie-in with the DMC problem (Scott et al. 2002), while others have substantiated an increased risk of detainment for drug use and public mental health insurance coverage of the adolescents (Brunelle et al. 2000). These two populations, adolescents with mental health problems and those involved in the juvenile justice system, often differ little across service delivery systems (Teplin et al. 2006).
Suicide
Many mental health and substance abuse problems place adolescents at high risk for suicidal ideation, attempts, and completions (Douglas et al. 2006; Gould et al. 2003). Suicide-related difficulties are challenging and often ongoing for the adolescent and their family; they are also more common than often realized. Suicide is the third leading cause of death among those ages 10–24 years (Child Trends 2010); with 1,000 completed suicides annually for adolescents aged 12–17 (Centers for Disease Control and Prevention 2008a; Substance Abuse and Mental Health Services Administration 2010a). Many more young people contemplate suicide and others make attempts that are not fatal. Of the nearly three million youth aged 12–17 who received mental health services in 2009 over 20 % reported seeking services for suicide-related problems (Substance Abuse and Mental Health Services Administration 2010b).
Risk factors associated with suicide among the adolescent population include a family or individual history of suicide, a history of depression, serious alcohol or drug abuse, loss, easy access to lethal methods, and incarceration (Centers for Disease Control and Prevention 2008a). Since incarceration is a risk factor, it follows that adolescent suicides and suicide attempts are more common within these facilities than among the general population.
Researchers have identified both a higher risk for youthful offenders while within these incarceration facilities and also a higher lifetime risk of suicide attempts. A national study of court-ordered youthful offenders in placement found that 110 completed suicides occurred between 1995 and 1999. Of the 79 cases with complete information it was found that 42 % of the suicides took place in secure juvenile court facilities and training schools, 37 % in detention centers, 15 % in residential treatment centers, and 6 % in reception or diagnostic centers (Hayes 2009). A similar review of youthful offenders in juvenile detention facilities in the 1980s found a suicide rate that was almost five times higher than for youths in the general population (Memory 1989). In addition, thoughts of suicide have been reported by as many as half of incarcerated youthful offenders (Esposito and Clum 1999), while large reviews of youth in custody, found that between 25 and 30 % reported these suicidal thoughts (Putnins 2005; Sedlak and McPherson 2010). Researchers have analyzed how facility characteristics may be related to suicide attempts and deaths (Gallagher and Dobrin 2005). One review found that facilities that house larger populations of youthful offenders and facilities that had locked sleeping room doors had the highest risk of suicide (Gallagher and Dobrin 2005).
Because the youthful offender population is disproportionately minority and male, it is important to note that adolescent males are more likely to die from suicide attempts, as well as use more violent means than females, though adolescent females are more likely to report attempting suicide (Centers for Disease Control and Prevention 2008a; Penn et al. 2003). Native American/Alaskan Native and Hispanic youth have been found to have the highest rate of suicide deaths (Centers for Disease Control and Prevention 2008b) and suicidal ideation (Graham and Corcoran 2003), while Caucasian adolescent females reported more incidents of suicide or self-injury than their African-American counterparts (Holsinger and Holsinger 2005).
However, predicting suicide risk is difficult, for risk factors vary in their impact and intensity. Not only incarcerated youthful offenders, but also those who are simply involved formally with the juvenile justice system, are at higher risk than non-incarcerated youth for suicidal behavior (Epstein and Spirito 2009; Evans et al. 2004; Rutter 2007; Thompson et al. 2007). Even when other risk factors—age, ethnicity, gender, alcohol and drug problems, depression, and impulsivity—were accounted for, delinquency was still related to suicidal ideation and attempts up to one year later and to ideation up to 7 years later (Thompson et al. 2007). Adolescents with an arrest history are more likely to report a suicide attempt than adolescents without an arrest history (Tolou-Shams et al. 2007).
In addition, demonstrating the impact of comorbid problems, young people in juvenile justice facilities who experienced maltreatment as children are more than twice as likely to have attempted suicide as their peers who had experienced maltreatment but were not in these facilities (Croysdale et al. 2008). Additionally, those who committed suicide had experienced rates of maltreatment 2–10 times greater than the general adolescent population (Hayes 2009). In a stark finding, 63 % of adolescents who had completed suicide between the years from 1996 to 1999 in Utah had previous contact with the juvenile justice system (Gray et al. 2002). Clearly, the risk of suicide for adolescents involved with the juvenile courts is significant; however, comorbid mental health problems and maltreatment victimizations have an impact.
Comorbidity
It is quite evident that these childhood and adolescent difficulties, maltreatment victimizations, and related problems are often interrelated or comorbid. These difficulties can last for weeks or perhaps for years, often greatly affect child and adolescent development and may combine with other challenges, leading to additional complicated problems. They may also predispose an adolescent to additional negative outcomes. Comorbidity within the child and adolescent population has been alternatively defined as the presence of more than one mental health disorder (Costello et al. 2004; Grisso 2008), the presence of a mental health disorder (often depression and conduct problems) and a substance abuse problem together (Goldstein et al. 2005; Green and Ritter 2000; Lexcon and Redding 2000; Wasserman et al. 2009), an emotional disorder and involvement with the juvenile justice system (Rosenblatt et al. 2000), psychiatric disorders prevalent across at-risk youth-caring systems (Garland et al. 2001), substance abuse problems and learning disabilities (National Center on Addiction and Substance Abuse 2000), maltreatment and delinquency (Center for Juvenile Justice Reform 2011; Petro 2008), and combinations of maltreatment, mental health problems, and delinquency (Teplin et al. 2002; Mallett 2009).
However comorbidity is defined, the various combinations of these disabilities and difficulties have made antecedent or concurrent youth-offending activity and delinquency outcomes difficult to understand. The complexities of how these difficulties affect children and adolescents, when and for how long they are experienced, and in what combinations have rarely been investigated. However, when such comorbid phenomena have been studied, difficult and complicated adolescent and family problems have come to light. In one review of five at-risk youth-caring systems—mental health, child welfare, alcohol and drug, juvenile justice, and public schools—it was found that over 54 % of all children and adolescents from all systems met criteria for at least one mental health diagnosis, with attention and disruptive behavior disorders being the most common (Garland et al. 2001). In a separate investigation of delinquent and juvenile court supervised youthful offenders, it was found that 32 % had an identified special education disability, 39 % had an identified mental health disorder, 32 % had an active substance abuse problem, 56 % had been victims of maltreatment, and over 40 % had comorbid problems, with higher disability prevalence rates found for youthful offenders who were detained or incarcerated (Mallett 2009). In a similar review of one jurisdiction’s mental health system and juvenile court, 20 % of adolescents receiving mental health services had a recent arrest record, while 30 % of adolescents arrested received mental health services (Rosenblatt et al. 2000). And in a unique study of the mental health problems of youthful offenders transferred from the juvenile court to the adult criminal court in Chicago, over 43 % of the youthful offenders had two or more psychiatric diagnoses (Washburn et al. 2008).
Additional investigations have supported linking these disabilities and difficulties. Children served within the community mental health system were three times more likely than children not served in the mental health system to be referred to the juvenile courts (Vander-Stoep et al. 1997), almost 40 % of adolescents referred for mental health services had prior juvenile justice system contact (Breda 1995); and over 44 % of youth were concurrently receiving community mental health services and were formally involved with the juvenile court (Bryant et al. 1994). The combination of ADHD and conduct disorder greatly increased the likelihood of serious and chronic youthful offending (Barkley 1996), as did the combination of anxiety or depression and a substance use disorder during adolescence (Frick 1998). Substance abuse frequently co-occurs with other mental health problems and disorders within the juvenile offender population, with depressive symptoms often comorbid with substance abuse (Neighbors et al. 1992). There are also strong associations between learning disabilities and subsequent struggles with substance abuse in adolescents (Kress and Elias 1993; Weinberg and Glantz 1999).
Of significant concern, and important to highlight again here, are the adolescents who are seriously emotionally disturbed, identified with multiple mental health disorders and related problems that continue into young adulthood. This group almost always has contact with the juvenile justice system, represents up to 20 % of youthful offenders within incarceration facilities, and continues to have offending problems and eventual involvement with the adult criminal courts (Cocozza and Skowyra 2000). It is estimated that one of every 10 adolescents who are seriously emotionally disturbed has both an impairing mental health disorder and an active substance abuse problem, a dual diagnosis which is particularly difficult to address in treatment (Chassin 2008).
Progress Made: Empirical Gaps Remain
This review of the empirical literature identified the high prevalence rates for these child and adolescent difficulties, as well as significant comorbidity, within the juvenile justice population. It found inordinately greater challenges for delinquent, detained, and incarcerated youthful offenders, as well as strong links from these difficulties to juvenile justice outcomes. In addition, it was found that many of these difficulties (maltreatment, trauma, and incarceration) disproportionately impact minority adolescents.
However, there are additional investigations, reviews, and studies needed to address certain empirical gaps within this child and adolescent population. These gaps include the following: (1) the limited knowledge of the impact that certain comorbidities have on the link to delinquency and incarceration, including mental health problems and learning disabilities, and also maltreatment and learning disabilities; (2) the causal relationships linking these risks to detention and incarceration, while controlling for other risk variables; (3) the school-to-prison pipeline and the causal connections from learning difficulties, problem behaviors, school personnel decisions, and juvenile court outcomes; (4) why DMC exists and what efforts can decrease the number of detained and incarcerated minority youthful offenders; (5) gender-specific pathways to delinquency and detention have been identified, but little is known about differential impact of interventions that can be used to minimize these outcomes for girls; and, (6) understanding and identifying youthful offenders who are most at risk for suicide. While these empirical investigations must be pursued, there are a number of important collaborative efforts across youth-caring systems that have addressed some existing barriers and problems.
Systems Collaboration
Coordination Barriers
Improved coordination across youth-caring systems is essential in improving these adolescent outcomes and diversion from ongoing offending behaviors. Social work is intimately involved in each of these child and adolescent problem areas—maltreatment, learning, and mental health—and can play a key role in improving future coordination efforts. While not without programmatic and policy barriers, these efforts can prove important.
Improved youthful offender outcomes can be achieved through better-developed coordination among the systems responsible for working with at-risk adolescents and those with disabilities—schools, child welfare, mental health, substance abuse, and the juvenile courts. However, supportive systems are nonetheless still often overwhelmed with the unmet disability needs of at-risk youth. Public schools, the juvenile courts, and community-based youth care agencies may lack the capacity to identify, let alone effectively address, the learning, trauma-related, and mental health problems of adolescents in their communities. The subset of this at-risk population, those with comorbid difficulties and risk factors, are of special concern to the juvenile courts because of the particular challenges in treating them and effectively minimizing harmful outcomes (Garland et al. 2001; Sebring et al. 2006).
Children and adolescents with such complex needs pose significant challenges to the supporting systems that are often designed to address a more narrow set of problems (Spain and Waugh 2005). Special education programs in schools are regulated by federal and state laws defining the problems; child welfare agencies are charged with identifying and protecting children and adolescents at risk for maltreatment; mental health and substance abuse agencies utilize psychiatric definitions to identify the child and adolescent difficulties; while the juvenile courts have the task of protecting both the adolescent and the community from further or pending offending acts. Sometimes these efforts are aligned toward addressing adolescent disability needs, but also they are in conflict with fights over the financing of treatment services and over responsibility in caretaking, with fragmentation of services, and with families forced to navigate between or among systems that have separate procedures, language, and expectations (Leone and Weinberg 2010; Mears and Aron 2003).
Barriers to coordination across systems can be substantial, and include, but are not limited to, inadequate understanding across systems, too many advocates working at cross purposes on behalf of the adolescents with disabilities, confidentiality concerns, and information sharing difficulties (Stone et al. 2007; US Department of Justice 2010; Weinberg et al. 2009). Though vital to coordination efforts, information sharing remains controversial because of concerns among stakeholders as to how certain sensitive information pertaining to matters such as child maltreatment, school problems, or arrest and conviction records may be utilized by other stakeholders (Mears and Kelly 1999). Still, some significant efforts have been made across some of these systems to improve coordination in achieving improved adolescent and family outcomes.
Successful Collaborations
Collaborative efforts to coordinate services among adolescents with comorbid problems are often pursued at the local or county level, where stakeholders and policy makers have many shared interests with this population. One local initiative that collaborates to serve adolescents in the foster care and juvenile court systems is the Family-to-Family initiative (sponsored by The Annie E. Casey Foundation) in six California counties. The focus among interagency work groups formed through this initiative is to identify barriers to service coordination and find solutions to these problems, with work group members including representatives from child welfare, county education, school districts, mental health, and probation, among others. Common barriers identified include agency attitudes and organizational structures that impede collaboration; legal violations, often with child welfare and/or the Individuals with Disabilities Education Act regulations; adversarial communications among agency workers; lack of knowledge of other agencies’ procedures; and youth placement instability (Leone and Weinberg 2010; Weinberg et al. 2009). In these counties, work group efforts changed and improved coordination, whereby the work group became the primary place where members collaborated and improved adolescent outcomes (for example, expedited school placement for those adolescents in foster care) (Weinberg et al. 2009).
Coordination between juvenile courts and school districts is clearly necessary in working with youthful offenders with learning disabilities and related academic and non-academic problems. The TeamChild Model addresses many of these coordination barriers. This program teams defense attorneys with social workers and other professionals to represent court-involved adolescents with disabilities who are at risk of or are being detained. Through advocacy and case management efforts during the adolescent’s formal court involvement, the team addresses education (including special education), mental health, vocational, and other needs as problems underlying delinquency and offending. The team works closely with the school districts and educates court personnel on non-justice related areas that affect the adolescent’s decision-making, academic limitations, and related problem areas. While not used extensively, this model has been found effective in decreasing detention and incarceration placement in several communities including Seattle, Washington (returning $2 in savings for every $1 spent within 6 months) (Washington State Institute for Public Policy 1998) and in Cleveland, Ohio (saving $620,000 in detention and incarceration costs over 18 months) (Mallett and Julian 2008).
Reform efforts to move away from detaining youthful offenders have been led by The Annie E. Casey Foundation’s Juvenile Detention Alternatives Initiative (JDAI), an almost two-decade movement to assist juvenile courts in decreasing their use of detention and improving youthful offender recidivism rates by focusing on risks and disabilities (Annie E. Casey Foundation 2009). JDAI works to decrease the use of detention through collaboration across youth-caring systems, including child welfare, mental health, schools, social service agencies; builds community-based rehabilitative alternatives; and utilizes standardized assessment instruments and data collection within juvenile courts to direct decision-making. Results, depending on length of implementation, have been positive in the over 150 jurisdictions in 35 states in which the JDAI has been involved. These results include the lowering of detention populations and reoffending rates, sometimes by over 40 %, and state incarceration placements by more than 34 %, thus often freeing up limited juvenile justice system resources to be used for more productive and cost-effective programming (Annie E. Casey Foundation 2009; Mendel 2011).
Conclusion
Not changing today’s juvenile justice system handling of youthful offenders with maltreatment victimization, learning and academic-related disabilities, and mental health problems will simply perpetuate this group’s disproportionate, though not inevitable, representation in the detained and incarcerated population. Without significant efforts across disciplines and youth-caring systems, these difficulties, along with the detention and incarceration experience itself, leave little hope for many of these adolescents, disproportionately minority, to successfully navigate into young adulthood. While there are 1,000 of adolescents incarcerated annually, and, as reviewed, most have multiple problems and difficulties that may have directly linked them to their offending behaviors, there is hope. If social work professionals and their counterparts in other youth-caring systems can continue and expand collaborative efforts in addressing these adolescent difficulties, outcomes can be improved. As demonstrated, detention and incarceration are not in any way inevitable for troubled adolescents, for underlying and contributive difficulties can be both identified and treated, helping to rehabilitate the young person.
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Mallett, C.A. Youthful Offending and Delinquency: The Comorbid Impact of Maltreatment, Mental Health Problems, and Learning Disabilities. Child Adolesc Soc Work J 31, 369–392 (2014). https://doi.org/10.1007/s10560-013-0323-3
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DOI: https://doi.org/10.1007/s10560-013-0323-3