Featured Article
Article Title
Psychiatric and Substance-Related Problems Predict Recidivism for First-Time Justice-Involved Youth
Authors
Marina Tolou-Shams, PhD - Professor at the University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA
Johanna B. Folk, PhD - Assistant Professor at the University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA
Evan D. Holloway, PhD - Postdoctoral Fellow at the University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA
Catalina M. Ordorica, MEd - Clinical Research Coordinator at the University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, San Francisco, CA
Emily F. Dauria, MPH, PhD - Assistant Professor at the University of Pittsburgh, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
Kathleen Kemp, PhD - Assistant Professor at The Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, Providence, RI
Brandon D. L. Marshall, PhD - Associate Professor at Brown University School of Public Health, Department of Epidemiology, Providence, RI
Abstract
Justice-involved youth with clinically significant co-occurring psychiatric and substance-related problems are at increased risk for recidivism. Less is known about how psychiatric symptoms (i.e., internalizing and externalizing) and substance-related problems (i.e., alcohol and cannabis) interact to predict recidivism, especially at first court contact. Among 361 first-time justice-involved youth aged 12 to 18, we used nested multivariate negative binomial regression models to examine the association between psychiatric symptoms, substance-related problems, and 24-month recidivism while accounting for demographic and legal covariates. Clinically significant externalizing symptoms and alcohol-related problems predicted recidivism. Moderation analyses revealed that alcohol-related problems drove recidivism for youth without clinically significant psychiatric symptoms, and externalizing symptoms predicted recidivism, regardless of alcohol-related problems. After accounting for other predictors, Latinx, Black non-Latinx, and multiracial non-Latinx youth were more likely to recidivate at follow-up than White non-Latinx youth. Systematic screening, referral, and linkage to treatment for psychiatric and substance-related problems are needed to reduce recidivism risk among first-time justice-involved youth. Differences in recidivism rates by race/ethnicity not attributable to behavioral health needs suggest it is imperative to concurrently deploy large-scale structural interventions designed to combat systemic racial bias and overrepresentation of ethnoracial minoritized youth within the juvenile justice system.
Keywords
juvenile justice; mental health; racial disparities; recidivism; substance use
Summary of Research
Youth involved in the justice system face heightened risks of recidivism, particularly when they experience co-occurring psychiatric and substance-related issues. Despite this recognized vulnerability, a significant gap exists in understanding the underlying mechanisms driving this association. This knowledge gap is particularly concerning given the critical need to develop effective interventions for these vulnerable youth. This study aims to understand the intricate interplay between psychiatric symptoms, substance-related problems, and recidivism among first-time justice-involved youth, intending to inform targeted interventions and mitigate the risk of further justice involvement.
Prior research has consistently identified substance use as a critical predictor of recidivism among both youth and adults involved in the justice system. Additionally, justice-involved youth often exhibit high rates of psychiatric disorders, further complicating their legal trajectories. Co-occurring psychiatric and substance-related problems are prevalent among these youth, with evidence suggesting that substance use moderates the association between psychiatric symptoms and recidivism.
The study included 361 first-time justice-involved youth aged 12 to 18 and their caregivers. The participants completed assessments using tablet-based, audio-assisted computerized methods in English or Spanish, with follow-up assessments conducted every four months for 24 months. The study utilized negative binomial regression to analyze the outcome of recidivism. Descriptive statistics were used for preliminary analyses, examining associations between various demographic, legal, psychiatric, and substance-related factors with recidivism. Measures included the Behavior Assessment System for Children, Second Edition for assessing psychiatric symptoms, and the Brief Young Adult Alcohol Consequences Questionnaire and Brief Marijuana Consequences Scale for substance-related problems.
The study findings underscore the critical need for targeted interventions to address the risk of recidivism among first-time justice-involved youth. Notably, approximately one-third of the sample recidivated, often accumulating multiple new charges over the 24 months, indicating the necessity for screening and intervention initiatives within this population. Consistent with previous research, clinically significant internalizing symptoms were associated with a lower likelihood of recidivism. In contrast, externalizing symptoms predicted a higher likelihood, even after controlling for various demographic and legal factors. These results emphasize the importance of targeting externalizing symptoms and alcohol-related problems in intervention efforts aimed at reducing recidivism among this population while also acknowledging the potentially protective role of internalizing symptoms against further justice involvement.
Furthermore, the study highlights the significance of incorporating substance-related problems into clinical screening and referral practices, with alcohol-related issues emerging as a particularly salient predictor of recidivism. However, the association between substance use and recidivism was complex, with differential impacts depending on the presence of psychiatric symptoms. Additionally, the study sheds light on the influence of race, ethnicity, gender, and age on recidivism rates, underscoring the pervasive impact of systemic factors such as institutionalized racism on justice involvement trajectories.
“The results suggest that circulating extremist ideologies in our society are inspiring idioms of distress and behaviors in a sub-group of patients with mental health disorders, and that this constitutes a challenging presentation which clinicians may have to address…The extremist ideologies of patients are aligned with violent extremism sociopolitical trends in the last decade…The relatively large group of patients referred for what proved to be non-ideological forms of violence reflects the growing attraction to mass killers and school shooters by youth…Finally, more recently, the referral of individuals for extremist behaviors (threats and violent acts) related to conspiratorial and anti-system beliefs may be related to the effects of the pandemic on violence…Our findings converge with a study of active shooters in the US [United States], with and without ideological motives…in which the most frequent diagnosis encountered were mood disorders, followed by stress related disorders. The high number of ASD [autism spectrum disorder] diagnoses among clients is also noteworthy and has been reported in the violent extremism literature (Faccini & Allely, 2017)…Overall, the clientele served by the team is clearly a psychiatric population in need of mental health services and cannot be characterized only as a forensic population. Notably, for many of our patients, distress was often increased by the involvement of security forces that infrequently recognized the severity of patient mental health problems (except in cases of psychosis)…” (p. 229).
“Results show that patients referred for violent extremism report multiple social grievances…Issues related to social isolation and family conflict, which affect half of our patients, are frequently found among extremists…The low community engagement and the high internet use complete the picture of individuals who are generally in the margins of society and may project onto this society (and too often onto their family) the responsibility for the perceived injustices they suffer. The internet plays a well-recognized role of echo chamber which confirms the legitimacy of these grievances largely shared by a resentful community…These grievances are, however, also common in psychiatric patients, and it is not possible to determine if social grievances have a causal role for our patient population, or if violent extremism rather constitute[s] a new way to express distress for patients who would have channeled their despair and rage differently in the past…” (p. 229).
Translating Research into Practice
Early Screening is Crucial: Screening youth for psychiatric symptoms and substance-related issues at their first encounter with the justice system is vital. This initial assessment can help identify those in need of behavioral health treatment.
Referrals Alone are Not Enough: Merely referring youth to services based on screening results is insufficient for engagement. Effective interventions must be matched to identified needs to reduce the risk of recidivism effectively.
Tailored Interventions are Effective: When justice-involved youth receive interventions that specifically address their identified needs, such as psychiatric or substance abuse treatment, the risk of reoffending decreases. Access to these tailored interventions is essential.
Culturally Responsive Approaches are Necessary: Implementing novel and culturally responsive interventions is crucial to engaging youth and their families in treatment services. This may involve practices like brief substance use and mental health interventions, such as the Family Check-Up model.
Integration with Community Services: Bridging the gap between the justice system and community-based behavioral health providers is vital. Family navigator services can be critical in facilitating this connection, ensuring that youth and their families receive the necessary treatment and support beyond the courtroom.
Other Interesting Tidbits for Researchers and Clinicians
“There are some limitations to the current study that can be addressed with future research. First, youth in the current sample were recruited from a single-family court, so findings should be replicated in other jurisdictions. Second, predictors of recidivism were self-reported data collected in the context of a research study conducted in the court setting, which may have led to underreporting of psychiatric symptoms or substance-related problems out of concern for court-related consequences; however, reported rates in both domains are high and consistent with prior research and are therefore likely to reflect accurate response patterns. Future recidivism risk studies of first-time justice-involved youth might consider incorporating a risk-needs-responsivity framework that examines multiple other criminogenic needs and responsivity factors not included in the current analyses to more holistically understand recidivism risk and the need for intervention. Third, our study was underpowered to examine differences in predictive associations within specific racial or ethnic subgroups because of sample size. Future research should explore whether alcohol use and externalizing symptoms, as well as their co-occurrence, predict recidivism at the same rate for Black and Latinx youth as white youth. Relatedly, future research should examine whether effective treatment of externalizing symptoms and alcohol use reduces inequities in future legal system contact. Finally, the current analyses did not examine structural-level mechanisms that place ethnoracial minoritized youth at increased risk for future court involvement, after controlling for the influence of psychiatric symptoms and substance-related problems. We acknowledge that our findings are limited to examining the relationship between the social construct of ethnoracial categories and recidivism without measures of individual, institutional, or structural racism.” (p. 44).
