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  3. The Mental Health Needs of Young Offenders
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    • Publisher:
      Cambridge University Press
      Publication date:
      August 2009
      September 2007
      ISBN:
      9780511543913
      9780521612906
      DOI:
      https://doi.org/10.1017/CBO9780511543913
      Dimensions:
      Weight & Pages:
      Dimensions:
      (247 x 174 mm)
      Weight & Pages:
      0.928kg, 468 Pages
      • Subjects:
      Psychiatry and Clinical Psychology, Medicine, Medical Law, Ethics and forensic Medicine, Psychiatry
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    Subjects:
    Psychiatry and Clinical Psychology, Medicine, Medical Law, Ethics and forensic Medicine, Psychiatry
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    Book description

    The majority of young people in the American juvenile justice system have diagnosable mental illnesses, including substance abuse, mental retardation and learning disorders. However, these often remain undetected and untreated. In this book, a team of experts examines the prevalence of mental disorders in this population and describes the means of screening for, diagnosing, and treating them effectively in a developmentally appropriate, culturally sensitive manner. They also examine psychopharmacologic and psychotherapeutic approaches; innovative alternatives to detention; the true costs of detaining youth; vulnerability to self-incrimination; and the alarming trend of minority confinement. Their comprehensive coverage includes discussion of ethical dilemmas and the need for preventive strategies and integrated approaches involving judicial, law enforcement, educational, and mental health professionals. This book will be of interest to both mental health and juvenile justice professionals.

    Reviews

    'This is a comprehensive book identifying the mental health needs of juvenile offenders. This is certainly the first step toward educating mental health and juvenile justice professionals and this book meets the goal.'

    Source: Journal of Psychosomatic Research

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    Contents

    Contents
    • 1 - An overview of child and adolescent mental health needs in the juvenile justice system
      pp 1-6
      • By Carol L. Kessler, Assistant Clinical Professor in the Department of Psychiatry, New York-Presbyterian, The University Hospital of Columbia and Cornell, 622 West 168 Street, Vanderbilt Clinic-Fourth Floor, New York, NY 10032 USA
    • View abstract

      Summary

      This chapter reflects the dedication of a diverse group of professionals to the needs of an oft neglected population. With the realization that most justice-involved youth silently suffer from mental health problems, professionals have begun to seriously study both the prevalence of the disorders, and how they might effectively be treated. The chapter provides an overview of the key themes discussed in the book, which indicates the broad range of child and adolescent mental health needs in the juvenile justice system. The book points to strategies for screening and for assessing mental health issues, and it also indicates emerging evidence-based treatment interventions. For paths toward rehabilitation and reintegration to be forged, and for knowledge to be translated into effective interventions, communities must commit resources to these at-risk youth. The chapter also presents an overview of how the other chapters of the book are organised.
    • 2 - Psychiatric disorders of youth in detention
      pp 7-47
      • By Linda A. Teplin, Owen L. Coon Professor of Psychiatry and Behavioral Sciences; Director Psycho-Legal Studies Program Feinberg School of Medicine Northwestern University 710 N. Lake Shore Drive Room 900 Chicago, IL 60611 USA, Karen M. Abram, Assistant Professor, Feinberg School of Medicine Northwestern University, USA, Gary M. McClelland, Research Assistant Professor, Feinberg School of Medicine Northwestern University, USA, Amy A. Mericle, Postdoctoral Fellow, University of California, San Francisco School of Medicine, Department of Psychiatry, USA, Mina K. Dulcan, Osterman Professor of Psychiatry, Behavioral Sciences, and Pediatrics Feinberg School of Medicine Northwestern University, USA, Jason J. Washburn, Research Assistant Professor, Feinberg School of Medicine Northwestern University, USA, Shiraz Butt, Assistant Professor of Psychiatry, Rush University Medical Center Marshall Field IV Building 1720 West Polk Street Chicago, IL 60612 USA
    • View abstract

      Summary

      A comprehensive understanding of the prevalence of psychiatric disorders among juvenile detainees is an important step toward meeting their needs. Although epidemiological data are key to understanding the psychiatric disorders of juvenile detainees, few empirical studies exist. This chapter lists studies published in the United States since 1990 that examined the diagnostic characteristics of incarcerated and detained juveniles. The Northwestern Juvenile Project was designed to overcome the methodological limitations in two ways. Four directions for future research are recommended: pathways to co-morbidity, studies of females in the juvenile justice system, longitudinal studies, and studies of vulnerability to posttraumatic stress disorder (PTSD) in high-risk youth. Research findings indicate that a substantial number of youth in detention need mental health services. However, providing services within the juvenile justice system poses a number of challenges: screening for mental health needs, providing services, community linkages, and avoid retraumatizing youth.
    • 3 - Disproportionate minority confinement
      pp 48-60
      • By William Arroyo, LA County Department of Mental Health Child, Youth and Family Administration 550 S. Vermont Avenue, Third Floor Los Angeles, CA 90020 USA
    • View abstract

      Summary

      The groups of minority youth to which disproportionate minority confinement (DMC) pertains are those identified by the federal government, namely, African American youth, Latino or Hispanic youth, Asian American youth, and American Indian youth. The research in this field has varied extensively in regard to sampling, jurisdictions, hypotheses, data collection, and other aspects of methodology. Any coordination of efforts or direct reporting of information to the Immigration and Naturalization Service expands the mound of challenges for some of these youth and their families. The Office of Juvenile Justice and Delinquency Prevention has sponsored several seminal publications relevant to DMC during the past decade. States have resorted to several actions to address DMC as a result of technical assistance among other reasons. The frequently adopted strategies have been community-based prevention, intervention, and diversion programs, and cultural sensitivity training.
    • 4 - Police interrogation of youth
      pp 61-78
      • By Allison D. Redlich, Policy Research Association, 345 Delaware Avenue Delmar, NY 12054 USA, Steven Drizin, 357 E. Chicago Avenue Room 370 McCormick Chicago, IL 60611 USA
    • View abstract

      Summary

      This chapter focuses on two vulnerability characteristics, young age and mental health, that can place people in jeopardy in the interrogation room. The jeopardy that exists, and for which there are not suitable safeguards, is the risk of police eliciting false and coerced confessions. To understand why youthfulness and mental disorder can place people at risk in the interrogation room, the chapter first describes current police interrogation methods, which rely heavily on psychological manipulation. Next, it examines the unique characteristics of youth and mental illness in the context of current interrogation techniques, and indicates how the potential for miscarriages of justice are intensified. The chapter concludes with recommendations and ideas for future research. Before describing current police interrogation techniques, it provides several points that should be explicitly stated and that serve as a basis.
    • 5 - Assessing children's competence to stand trial and to waive Miranda rights: new directions for legal and medical decision-making in juvenile courts
      pp 79-121
      • By Thomas F. Geraghty, Director of the Blum Legal Clinic, Northwestern University School of Law 357 E. Chicago Avenue Chicago, IL 60611-8576 USA, Louis J. Kraus, Womans Board Professor of Child and Adolescent Psychiatry and Chief Department of Child and Adolescent Psychiatry, Rush University Medical Center Marshal Field IV Building 1720 West Polk Street Chicago, IL 60612 USA, Peter Fink, Assistant Professor of Psychiatry, Rush University Medical Center Marshall Field IV Building 1720 West Polk Street Chicago, IL 60612 USA
    • View abstract

      Summary

      This chapter begins with an overview of the history of the law relevant to the issues of a child's competence to stand trial. It discusses the legal and medical frameworks for assessing a child's competence to stand trial. The chapter analyzes the legal and medical frameworks and methodologies for assessing a child's competence to waive Miranda rights. It turns to the methods by which lawyers and medical personnel evaluate a child's competence in these areas. These assessments play a central role in determining the admissibility into evidence of children's statements to law enforcement. The chapter includes a section on the interactions and relationships between the judges, lawyers, and medical experts who participate in the assessment process and in the process of adjudicating competence to stand trial and children's capacity to make a knowing, intelligent waiver of Miranda warnings. The issues are of central importance to the juvenile court's adjudicative process.
    • 6 - The etiology of antisocial behavior: biopsychosocial risk factors across development
      pp 122-145
      • By Kayla Pope, University of Manykind Sheppard Pratt 701 West Pratt Street Suite 476 Baltimore, MD 21201 USA, Christopher R. Thomas, Professor of Psychiatry and Behavioral Sciences, University of Texas 301 University Boulevard Galveston, TX 77555 USA
    • View abstract

      Summary

      Understanding criminal behavior as a biological or physiological phenomenon has continued in its ascendancy by advances made in the fields of genetics and neuroscience in understanding behavior. The development of criminal behavior is a biopsychosocial phenomenon, and factors that influence its development derive from multiple sources, ranging from genetic heritability to gang participation. Risk factors associated with the development of criminal behavior are found for each developmental phase, with the most significant risk factors for each developmental period being those that influence the achievement of developmental milestones. Thus, during infancy, factors that interfere with the formation of a secure attachment appear to be most detrimental while during adolescence, risks associated with peer relationships are critical. This chapter explores these biological and environmental risk factors and their effect on behavior across development. Given the individual and societal costs associated with antisocial behavior, the benefits of such an investment seem clear.
    • 7 - Substance abuse in youth offenders
      pp 146-179
    • View abstract

      Summary

      Nearly two-thirds of males and three-quarters of females in the juvenile justice system have at least one psychiatric disorder as opposed to 20 percent of all children. In order to avoid youth involvement with the juvenile justice system, more emphasis needs to be placed on the early detection and intervention. This chapter concentrates on all risk factors that increase the risk for substance abuse, including psychiatric disorders. Clearly, all agencies involved with the juvenile justice system must continue to educate themselves about the mental health issues of these youth, and work to coordinate services and follow-up in order to, hopefully, turn negative risk factors into protective factors. In this way, these adolescents may not continue to move in a direction that leads to a lifelong history of crime and recidivism.
    • 8 - Suicide and delinquent adolescents
      pp 180-197
      • By Amer Smajkic, Rush University Medical Center Marshall Field IV Building 1720 West Polk Street Chicago, IL 60612 USA, David C. Clark, Rush University Medical Center Armour Academic Center 600 Paulina Suite 529 Chicago, IL 60612 USA
    • View abstract

      Summary

      To review suicide and suicide attempt trends in jails and prisons, it is important to begin with an explanation of the distinction between "jails" and "prisons". Among all children and adolescents, those incarcerated in the juvenile or criminal justice systems are at the highest risk for serious suicide attempts. A number of studies of suicide by delinquent adolescents focus on individual psychological and psychiatric risk factors, past suicide attempts and thoughts, sexual victimization, and gang affiliation, as well as demographic factors. The chapter talks about other risk factors for fatal suicide in the delinquent youth population, and Lindsay Hayes' survey on juvenile suicide in confinement. Mental health services available to adolescent delinquents and their living conditions within the juvenile system has recently become a focus of research. The existence of juvenile institutions and their underlying missions are based in part on the belief that delinquents are amenable to behavior change.
    • 9 - Juvenile sex offenders
      pp 198-228
      • By Corinne Belsky, 98-A Cope Creek Rd Sylva, NC 28779 USA, Wade C. Myers, Professor and Chief, Division of Child and Adolescent Psychiatry Director, Forensic Psychiatry Program Department of Psychiatry, Silver CDC University of South Florida 12901 Bruce B. Downs Blvd., MDC 102 Tampa, FL 33612 USA, Daniel Bober, Forensic Psychiatry Fellowship University of Massachusetts Medical School 55 Lake Avenue North, WSH 8B Worcester, MA 01655 USA
    • View abstract

      Summary

      Given the magnitude of juvenile sexual offenses and the toll they take on society, it is surprising they were not consistently taken seriously until at least the 1970s. As it is evident from the material presented in this chapter, perhaps the most overarching principle pertaining to juvenile sex offenders is that they are a heterogeneous population. Having said this, they do share some commonalties. A number of sex offender categorization schemes are described. The chapter presents different types of juvenile sex offenders along with selected case vignettes. The two primary physiological assessments used in sex offenders are phallometry and polygraphy. Different sexual offender pathways are an interesting concept to consider when looking at risk of recidivism. Becker and Kaplan described three paths the juvenile sex offender takes: dead-end, delinquency, and sexual interest paths. For most sex offenders a "cure" is not realistic, and instead, an ongoing management strategy is required.
    • 10 - Educational needs of youth in the juvenile justice system
      pp 229-240
      • By Malika Closson, University of Maryland, Department of Psychiatry, 701 West Pratt Street Baltimore, MD 21201 USA, Kenneth M. Rogers, University of Maryland, Department of Psychiatry Section of Child and Adolescent Psychiatry, 701 West Pratt Street Baltimore, MD 21201 USA
    • View abstract

      Summary

      Data, with regard to overrepresentation in the juvenile justice system, show that the majority of youth in juvenile correctional settings are from either urban or rural communities. Several authors have suggested ways to improve delivery of appropriate educational programming to youth in juvenile correctional settings. One key component in ensuring that youth in juvenile correctional facilities receive the educational services they require is the implementation of a referral process by which all eligible youth with disabilities who enter a facility can be identified and assessed within a prescribed timeline. This process should include the identification of eligible youth with no prior history of special education, in addition to identification of youth who received special education services from previous school systems but who do not have a current individualized education plan (IEP). Additionally, youth with learning disabilities, mild to moderate mental retardation, and developmental delays are overrepresented in juvenile correctional settings.
    • 11 - Science and the juvenile death penalty
      pp 241-254
    • View abstract

      Summary

      The Supreme Court's Eighth Amendment analysis in death penalty cases is based on two principles. The first is whether "standards of decency" have evolved to the point where there is now national consensus that a particular form of punishment has become cruel and unusual. A second issue the Court has to address is whether the constitutionally legitimate purposes of the death penalty are applicable to this particular group of offenders. In coming to a conclusion regarding the level of culpability, and therefore the appropriate punishment, for 16- and 17-year-old offenders, the Court had to look outside the law and to science. Pivotal to the ultimate outcome in Roper v. Simmons was the involvement of the sciences and their instruction to the public, policy makers, and law makers prior to the Court taking up the case. Later, the Court considered the research and conclusions of the behavioral, medical, and neurological sciences.
    • 12 - Medical issues regarding incarcerated adolescents
      pp 255-269
    • View abstract

      Summary

      Incarcerated teens are at risk for a wide variety of injuries and illnesses. Careful screening and follow-up assures the teen will medically benefit from incarceration and improve their chances of rehabilitation. This chapter is divided into four sections: medical problems that may predispose to delinquent behavior; medical illness and injury likely to result from delinquent behavior; health concerns for all adolescents; and health maintenance issues. Governmental agencies advocate for appropriate research and have built-in safeguards for all research involving prisoners, including stipulating the types of permissible research. Medical personnel at large facilities should be involved as primary investigators or as collaborators with other investigators. Conducting sound ethical, targeted research will greatly aid progress in reducing the burden of crime and illnesses for juvenile delinquents. Cooperation is necessary among medical, custody, and judicial personnel to obtain funding for studies and to facilitate the conduct of research.
    • 13 - Mental health screening and assessment in juvenile justice
      pp 270-287
      • By Gina M. Vincent, Department of Psychiatry, University of Massachusetts Medical School 55 Lake Avenue North, WSH 8B Worcester, MA 01655 USA, Thomas Grisso, Professor, Law and Psychiatry Program Department of Psychiatry University of Massachusetts Medical School 55 Lake Avenue North, WSH 8B Worcester, MA 01655 USA, Anna Terry, Research Associate, Law & Psychiatry Program Department of Psychiatry University of Massachusetts Medical School 55 Lake Avenue Norh, WSH 8B Worcester, MA 01655 USA
    • View abstract

      Summary

      This chapter provides a brief description of the benefits and procedures of mental health screening and assessment in juvenile justice settings. It begins with a discussion of the reasons for and benefits of identification of mental health problems in juvenile justice settings, and the developmental complications involved in this undertaking. The chapter defines and differentiates mental health screening versus assessment by describing the characteristics of both. Finally, it provides a brief review of the current mental health screening tools, which are in the public domain and have been validated for use in juvenile justice settings. The screening tools are defined along three categories: multidimensional brief screening tools, problem or needs-oriented interview schedules, and multidimensional scales identifying clinical disorder. The selection of tools must be commensurate with the purposes, demands, and constraints of the situations in which they will be used.
    • 14 - Psychological testing in juvenile justice settings
      pp 288-307
      • By Ruth Kraus, 950 Skokie Boulevard Suite 305 Northbrook, IL 60062 USA, Julie Wolf, Yale Child Study Center 230 South Frontage Road New Haven, CT 06520 USA
    • View abstract

      Summary

      Children and adolescents generally enter the juvenile justice system as a result of externalizing behavior problems. Several areas of neuropsychological function have been the focus of studies of adolescent delinquency, and deficits in two areas, namely, executive functioning and verbal ability, have been associated with delinquency. Furthermore, preschoolers with co-morbid attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) were more likely to have verbal deficits than those with ODD alone. Some researchers have identified neuropsychological profiles associated with patterns of recidivism among adolescent delinquents. This chapter presents an overview of some of the most common instruments used to assess intelligence, cognition, executive function, academic achievement, personality, and behavior. All of the measures described have normative data based on national samples, and are published measures. It presents a few examples of each type of measure. The chapter also talks about personality questionnaires and behavioral questionnaires.
    • 15 - Psychopharmacology and juvenile delinquency
      pp 308-339
      • By Niranjan S. Karnik, Division of Child and Adolescent Psychiatry Stanford University 401 Quarry Road Stanford, CA 94305 USA, Marie V. Soller, Resident in Psychiatry San Mateo Medical Center San Mateo, CA USA, Hans Steiner, Professor of Psychiatry and Behavioral Sciences, Director of Education, Division of Child and Adolescent Psychiatry Co-Director, Center for Psychiatry and the Law Stanford University School of Medicine 401 Quarry Road Stanford, CA 94305 USA
    • View abstract

      Summary

      Several controlled clinical trials of medications in youth make it clear that psychopharmacology can significantly contribute to rehabilitation and possibly recovery. This chapter summarizes the clinical indications for pharmacological interventions that may help in reducing pathology in this population. The combined knowledge of clinical care, clinical trials, and the recommendations generated by consensus in practice guidelines suggests that the most appropriate approach to using medications in juvenile offenders requires employing a cautious and supportive attitude, and always weighing risks and benefits. The chapter proposes that clinicians should use the integrated provision of services, including medication, to attempt to target the subtype of aggression that may be underpinning the delinquent behaviors of the juvenile. It summarizes the trials where the primary recruitment target was a disorder of aggression, conduct disorder (CD), oppositional-defiant disorder (ODD), and intermittent explosive disorder (IED). In all cases, clinicians should strive to use evidenced-based principles for treatment.
    • 16 - Evidence-based treatment for justice-involved youth
      pp 340-367
      • By Eric Trupin, University of Washington, Public Behavioral Health, 146 North Canal Street, Suite 100 Seattle, WA 98103 USA
    • View abstract

      Summary

      This chapter pinpoints the conceptual foundations and treatment strategies for early intervention and community-based treatment programs, and provides case examples illustrating the unique features of each approach. In addition, it presents two promising transition programs with implications for treatment of youth in secure programs prior to their participation in community-based aftercare treatments. Early intervention and community-based treatment programs are intended to provide alternatives to secure facilities for juveniles involved in criminal activity. These approaches are analogous to strategies used in public health to prevent, control, and reduce the impact of illness on quality of life, morbidity, and mortality. Two examples of early intervention programs include diversion programs and mentoring programs. All of the common characteristics of evidence-based programs highlighted in the chapter must be attended to and fulfilled, including: qualities of effective providers; training and protocol adherence; clinical supervision; and collaboration with stakeholders in the system.
    • 17 - Community alternatives to incarceration
      pp 368-384
      • By Christopher R. Thomas, Professor of Psychiatry and Behavioral Sciences, University of Texas 301 University Boulevard Galveston, TX 77555 USA
    • View abstract

      Summary

      Effective community based interventions offer several advantages over residential programs. The most obvious is the cost savings, with funds devoted to treatment services rather than the additional burden of facilities. More important is the ability to treat the youth within the context of home and community. The treatment team can directly assess the family and neighborhood factors that contribute to continued delinquency and determine what resources are available for change. If the safety and containment of adjudicated youth permit, community based interventions are preferable. Meta-analytic studies have provided more detailed overview of community based delinquency programs. It is also instructive to consider delinquency programs that have failed to produce the desired results. Two examples that have received a great deal of popular attention are "wilderness challenge" and "boot camp". In order to better address the multifaceted nature of delinquent behavior, more programs are emphasizing a systems approach in treatment.
    • 18 - Innovative problem-solving court models for justice-involved youth
      pp 385-400
      • By Carol L. Kessler, Assistant Clinical Professor in the Department of Psychiatry, New York-Presbyterian, The University Hospital of Columbia and Cornell, 622 West 168 Street Vanderbilt Clinic-Fourth Floor New York, NY 10032 USA
    • View abstract

      Summary

      Problem-solving courts search for young people's strengths, and endeavor to support youth with needed educational, vocational, health, and mental health services. They seek to deliver services in a culturally relevant, developmentally appropriate manner, and they strive to link youth to effective aftercare. The youth court model evolved gradually over the last half century. Restorative justice conferences base their effectiveness on "principles of control, deterrence, and reintegrative shaming". Developers of mental health courts recognized the silo effect of two systems, mental health and juvenile justice, working independently to address the needs of the same severely emotionally and behaviorally disturbed youth who commit delinquent acts. Juvenile drug courts, mental health courts, and peer courts are innovative responses to justice-involved youth that restore the rehabilitative mission of the juvenile justice system. They promise to avoid the economic, and more importantly, the human cost of detention and punishment.
    • 19 - Ethical issues of youthful offenders: confidentiality; right to receive and to refuse treatment; seclusion and restraint
      pp 401-422
      • By Lilia Romero-Bosch, Chief Resident Hasbro and Rhode Island Hospitals Providence, Rhode Island 02903 USA, Joseph V. Penn, Director of Child and Adolescent Forensic Psychiatry Rhode Island Hospital, RI Training School Medical Clinic, 300 New London Avenue Cranston, RI 02920 USA
    • View abstract

      Summary

      This chapter provides an overview of some relevant ethical issues, confidentiality, right to assent to and right to refuse treatment, seclusion, and restraint, which frequently arise in the context of evaluation and treatment of juvenile offenders. It has applicability to psychiatry, psychology, social work, and other child mental health professionals. The terms, clinician and forensic evaluator, apply to various disciplines in these settings. Attempts to meet the needs of youth offenders rely on inter-agency collaboration and adherence to established standards of care. In addition, there needs to be continued development and validation of: (1) mental health screening for juveniles across juvenile justice and correctional settings, (2) further research on the prevalence of mental illness and the efficacy of various treatments for youth offenders, and (3) continued debate regarding legal and ethical implications of treatment specific to minors.
    • 20 - Post-adjudicatory assessment of youth
      pp 423-436
      • By Louis J. Kraus, Womans Board Professor of Child and Adolescent Psychiatry and Chief Department of Child and Adolescent Psychiatry, Rush University Medical Center Marshal Field IV Building 1720 West Polk Street Chicago, IL 60612 USA, Hollie Sobel, Assistant Professor of Psychiatry and Behavioral Sciences, Rush University Medical Center 1720 West Polk Street Chicago, IL 60612 USA
    • View abstract

      Summary

      The post-adjudicatory evaluation serves to assess the child in association with review of all available collateral information. The referral for this type of evaluation typically comes from the court, possibly probation, or any of the involved attorneys. Consistency in the evaluation, knowledge of available community resources, and expertise in juvenile delinquency, in the context of a developmental framework, are all necessary so that appropriate interventions can be put into place. The post-adjudicatory, or dispositional, stage is considered the most critical decision-making component of juvenile court. An understanding of local and available facilities is important, including wraparound services, residential programs, and community-based services that can be included within the wraparound interventions. It is important to identify one's role within the evaluation, and for the youth to realize that the purpose of the assessment is not for treatment, nor is it confidential.

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