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Relevant Center Publications:

Leenarts, L, McReynolds LS, Vermeiren R, Doreleijers T. (In press). Associations between Trauma History and Juvenile Sexual Offending. Journal of Trauma and Treatment.

Objective: To examine the contributions of demographic characteristics, mental health problems and interpersonal trauma history to juvenile sexual offending, and the degree to which juvenile sexual offenders differ from nonsexual interpersonal offenders. Method: Results are based on secondary analysis of a large dataset (n = 2920) of standardized psychiatric assessments of juveniles, resulting from nationwide collaborations with juvenile justice agencies (57 sites in 18 states) in the USA. Via t-test and chi-square analyses, demographic, offense, and diagnostic characteristics of juvenile sexual offenders and nonsexual interpersonal offenders were compared. In addition, logistic regression examined the relationship between type of trauma exposure and sex offender status, adjusting for other significant demographic and diagnostic contributors. Results: Results show that compared to juvenile nonsexual interpersonal offenders, sexual offenders were significantly less likely to be female, to be African American, or to meet criteria for a substance use disorder; juvenile sexual offenders were significantly more likely to have a lifetime history of a suicide attempt and a history of sexual victimization. A set of demographic and diagnostic characteristics contributed significantly to juvenile sexual offending, as did self-reported history of sexual trauma. Conclusions: Findings indicate that juvenile sexual offenders in some aspects differ from nonsexual interpersonal offenders; sexual victimization plays an important role in explaining sexually abusive behavior. Further research should identify interventions that are effective for these youth.

Hoeve M, McReynolds LS, Wasserman GA. (2013). The influence of adolescent mental health disorders on young adult recidivism. Criminal Justice and Behavior.

Secondary multiple regression analyses related disorder profile, probation officers' mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receive service referrals. Substance disordered youths with service referrals had lower recidivism risk compared to counterparts without referrals; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk.

Hoeve M, McReynolds LS, Wasserman GA. (2013). Service Referral for Juvenile Justice Youths: Associations with Psychiatric Disorder and Recidivism. Administration and Policy in Mental Health and Mental Health Services Research.

Secondary multiple regression analyses related disorder profile, probation officers' mental health/substance use service referrals, and recidivism in 361 juvenile justice youths. Those with externalizing (disruptive behavior or substance use) disorder or substance offenses were most likely to receive service referrals. Substance disordered youths with service referrals had lower recidivism risk compared to counterparts without referrals; referral lowered the recidivism odds to approximately that for youths without a substance use disorder. Providing juvenile justice youths with systematic mental health assessment and linking those with substance use disorder to mental health and substance use services likely reduces recidivism risk.

Lyons C, Wasserman GA, Olfson M, McReynolds LS, Musabegovic H, Keating JM. (2013). Psychotropic Medication Patterns among Youth in Juvenile Justice. Administration and Policy Mental Health and Mental Health Services Research, Vol. 40:58–68.

This paper aims to determine the prevalence, patterns, and demographic and diagnostic correlates of psychotropic medication use in a sample of youth in one state's post-adjudicatory secure facilities. The health records database of the facilities was the source of linked demographic, diagnostic and pharmacy information for the 1-year period ending June 30, 2008. Age, gender, race, offense, prior petitions and diagnoses were examined across groups, and concomitant psychotropic pharmacotherapy patterns were identified. Period prevalence was 10.2% for youth ranging in age from 12 through 22 years who had any psychotropic drug prescribed during the first 30 days after intake to the facility. Among medicated youths, almost half received concomitant therapy. Medicated youth were significantly less likely to be Hispanic and more likely to endorse one or more diagnoses. Antidepressants, antipsychotics and antihistamines were the most commonly dispensed agents. Our findings revealed that the rate of psychotropic medication use was low, concomitant medication use was common, and ethnic/race differences in psychopharmacologic treatment were present in this sample of youths in post-adjudicatory secure facilities.

Hoeve M, McReynolds LS, McMillan C, Wasserman GA. (2013). The influence of mental health disorders on severity of re-offending in juveniles. Criminal Justice and Behavior. Vol. 40(3), 289-301.

The authors conducted secondary data analyses on mental health assessment and offense history data for 700 juveniles referred to juvenile justice agencies in Alabama (probation and detention). Multiple regression analysis was applied to predict subsequent offense severity by disorder profile, adjusting for prior offense severity and background variables. Juveniles with a substance use disorder with or without co-occurring disorders were at greater risk for escalations in offense seriousness over time. Early in juvenile justice system contact, juveniles should get effective treatment for substance use to prevent offending escalation.

McReynolds, LS & Wasserman, GA. (2011). Self-injury in incarcerated girls: contributions of mental health and traumatic experiences, Journal of Traumatic Stress. Vol. 24 (6), 752-755.

Despite evidence supporting a connection between child maltreatment and self-injury, there is disagreement regarding a particular connection to sexual abuse because types of trauma exposure often co-occur. To examine these associations efficiently, we considered a sample of incarcerated juvenile females, where rates of both trauma exposure and self-injury would be expected to be elevated. Adolescent females (N = 220) reported on history of self-injurious behavior on the Voiced Index of Self-injurious Actions, as well as psychiatric disorder. A common set of features was associated with cutting and with self-injury in general. Both were more likely in those initiating delinquent activities when younger and in those currently meeting criteria for major depressive disorder, or with a previous suicide attempt. Adjusting for those features, report of self-injury was approximately doubled among those disclosing prior traumatic exposure that was sexual, OR = 2.66, 95% CI [1.38, 5.15], or nonsexual, OR = 2.18, 95% CI [1.17, 4.04]. Exposure to early traumatic events, such as child maltreatment, likely contributes to a set of adverse experiences, including delinquent activity, mood disorder, and self-injury. Findings contribute to work demonstrating the importance of dissociation both as a consequence of victimization and as a key feature underlying self-injurious behavior.

Wasserman, G.A. & McReynolds, L.S. (2011). Contributors to traumatic exposure and posttraumatic stress disorder in juvenile justice youths. Journal of Traumatic Stress. Vol. 24(4): 422-429.

This study considers demographic, offense, and disorder contributors to exposure and posttraumatic stress disorder (PTSD) in a large (N = 9,611) dataset of standardized psychiatric assessments resulting from nationwide collaborations with justice agencies. Youths' antisocial history may elevate risk for traumatic exposure and PTSD; additionally, traumatic victimization increases risk for externalizing behavior. Rates of all types of traumatic exposure and PTSD were clearly elevated and expectably related to disorder and antisocial behavior. Males were significantly more likely than females to report assaultive violence, whereas females were significantly more likely than males to report forced sexual activity. Gender interactions with disorder and antisocial behavior were contributory only in predicting forced sexual activity: females' exposure was not conditional on features characterizing males' exposure. Findings highlight the high levels of trauma exposure at all levels of juvenile justice processing, and the particular vulnerability of males with internalizing psychopathology. Consistent with increased recent interest in the diagnosis of developmental trauma disorder, and given the likely interconnectedness between traumatic exposure and externalizing symptoms, treatment approaches for justice youths should address their co-occurrence.

Wasserman GA, McReynolds LS, Schwalbe CS, Keating JM, Jones SA, Disorder, comorbidity and suicidal behavior in juvenile justice youth. Criminal Justice and Behavior, Vol 37(12):1361-1376. (link to article online)

Results of collaborations with juvenile justice agencies nationwide were examined to provide generalizable estimates of psychiatric disorder and suicidality among justice system youth. Diagnostic assessments were aggregated from 57 sites (N =9,819) from an automated computer-assisted self-interview (Voice Diagnostic Interview Schedule for Children). Disorder was predicted from setting type (system intake, detention, corrections), adjusting for demographic and offense characteristics, and for cross-site variability within settings. Race by comorbid disorder interactions were examined in predicting substance use disorder (SUD). White youth, repeat offenders, and those with further justice system penetration reported higher rates of most disorders; girls reported higher rates of internalizing conditions only. Although presence of another disorder increased SUD for most groups, SUD was high in American Indians regardless of either affective disorder or recent suicide attempt. Findings highlight (a) varying mental health needs across settings, (b) prior justice contact relating strongly to need, (c) girls’ elevated rates of internalizing disorder, and (d) racial/ethnic differences in diagnostic profiles.

Wasserman GA, Young K, McReynolds LS, Keating J, Fisher P, Huo Y, & Turner JB. (2010). Conduct and Oppositional Defiant Disorder: Patterns of symptoms in youth classified as delinquents and Persons in Need of Supervision. Report on Emotional and Behavioral Disorder in Youth, 10(1); 3-10.

Justice and mental health practitioners consider different approaches to adolescent misbehavior nosology. While DSM-IV posits two related disorders (Conduct and Oppositional Defiant Disorder-CD and ODD), juvenile justice practices differ for status offenders (Persons In Need of Supervision: PINS) and juvenile delinquents (JDs). Little is known about how CD and ODD symptom patterns relate to these justice classes. Diagnostic interviews (V-DISC) with 230 JDs and 248 PINS youths, revealed equivalent disorder rates; PINS were more likely female and older. Factor analysis of CD and ODD symptoms validated overlap between mental health and justice perspectives. PINS youths were more likely to endorse Oppositional Behavior. JDs endorsed more Illegal Behavior. CD symptoms corresponding to status offenses loaded on the Authority Challenging Behavior factor, common to both groups. Authority Challenging Behavior is distinguishable from more clearly oppositional or illegal activities. Future nosological discussion should distinguish between CD symptoms reflecting Illegal vs Authority Challenging Behavior.

McReynolds LS, Schwalbe C, Wasserman GA. (2010). Contribution of psychiatric disorder to juvenile recidivism. Criminal Justice and Behavior, 37 (2); 204-216.

Youths formally referred to probation authorities in Texas (791 male, 200 female) self-administered a structured diagnostic interview at intake. Data on demographics, offense characteristics, and reoffending (within 12 months of baseline) were extracted from official justice records. Logistic regression analyses were used to evaluate the contribution of diagnosis to recidivism, adjusting for demographic and offense characteristics. Baseline externalizing disorders were associated with increased recidivism risk for both genders, whereas youths’ recidivism risk was not influenced by anxiety disorder. Girls with comorbid substance use and affective disorder were nearly four times more likely to reoffend than girls with no disorder. In contrast, among males, this disorder profile was associated with only approximately half the level of recidivism risk. Results substantiate practice guidelines that recommend comprehensive mental health assessment in juvenile justice settings and identify youths with certain mental health needs who might be well served by diversion programs.

Wasserman GA, McReynolds LS, Whited AL, Keating JM, Musabegovic H, & Huo Y. (2009). Evaluating Project Connect: Improving juvenile probationers’ mental health and substance use service access. Administration and Policy in Mental Health, 36, 393-405.

Project Connect is a multilayered countyspecific program aimed at linking juvenile probationers to needed mental health and substance use services. In four NY counties, the intervention included cooperative agreements between probation and mental health authorities, program materials to facilitate referral, in-service training for probation officers, and systematic screening for mental health needs. Charts for 583 Baseline youths were reviewed and compared with 594 youths undergoing intake under Project Connect. Compared to Baseline, under Project Connect, referred youths were 2.7 times as likely to access services, regardless of youth or county characteristics, service availability, or when the intervention took place.

Wasserman, G.A., McReynolds, L.S., Whited, A.L., Keating, J.M., Musabegovic, H., & Huo, Yanling (2008). Juvenile probation officers’mental health decision making, Administration and Policy in Mental Health, 35, 410-422.

We reviewed case records for 583 juvenile delinquency intakes in four county juvenile probation offices; 14.4% were receiving mental health or substance use services at case opening, and 24.9% were newly identified during probation contact. Youths were significantly more likely to be newly identified if they were repeat offenders, if their probation officer knew more about mental health and if they resided in a county without a shortage of available mental health professionals. Probation officers were especially likely to underidentify internalizing disorders. Policy implications for promoting identification of mental health needs and improving linkage to community service providers are discussed.

McReynolds, L.S., Wasserman, G.A., & John, R. (2008) Risk for disciplinary infractions among incarcerated male youths: influence of psychiatric disorder, Criminal Justice and Behavior. 35, (9), 1174-1185.

The authors examine the contribution of disorder to disciplinary infractions among incarcerated male youths. In all, 176 youths recently admitted to a secure assessment center self-administered the Voice Diagnostic Interview Schedule for Children–IV. Demographic and justice-related data were abstracted from official records. Younger boys, minority youths, and those who stayed longer were found to infract more. Controlling for these factors, infraction risk was significantly lowered by anxiety, affective disorder, disruptive behavior, or substance use disorder (vs. no disorder), as well as more or more types of disorder. Youths with mental health concerns were less likely to infract. Results highlight the importance of employing systematic and universal screening rather than relying on observable management problems to identify mental health needs.

Nolen, S., McReynolds, L.S., DeComo, R.E., John, R., Keating, J.M., & Wasserman, G.A. (2008) Lifetime suicide attempts among Juvenile Assessment Center Youth, Archives of Suicide Research, 12 (2) 1-13.

To describe suicide risk in youth seen at a Juvenile Assessment Center (JAC), we examined relationships among self-reported lifetime attempts and demographic, justice, and psychiatric data via logistic regression. Similar to other settings, youth reporting lifetime attempts were more likely to be older, female, not living with both parents and currently arrested for a violent or felony crime. Mood, substance use and behavior disorder each increased prediction substantially. Anxiety Disorder was associated with elevated attempt rates for boys only. JACs need to develop protocols for identifying suicide risk; further, since suicide history predicts future attempts, Anxiety Disordered boys may be at particular risk.

McReynolds, L.S., Wasserman G.A., DeComo, R.E., John R, Keating, J.M.,& Nolen, S. (2008) Psychiatric disorder in a juvenile assessment center, Crime and Delinquency, 54 (2) 313-334.

Juvenile assessment centers (JACs) were developed to address service fragmentation and promote the sharing of information among agencies providing services to youth involved with the juvenile justice system. To date, there are no reports that describe the diagnostic profiles of the youth served by such centers. The authors hypothesize that the rates of psychiatric disorder among youth at JAC intake would be lower than rates reported for youth in secure care, that girls would show higher rates of some disorders, and that those with substance disorders would show higher rates of other, co-occurring disorders. Disorder was measured on the Voice Diagnostic Interview Schedule for Children in 1,012 randomly selected youth (248 girls). Rates of disorder for JAC youth are lower than those reported for incarcerated samples and more comparable to other general intake samples; JAC youth’s diagnostic profiles remain elevated compared to youth in the general population, and girls report higher rates of disorder in three of four diagnostic clusters examined. Clinical and policy implications are discussed.

McReynolds, L.S., Wasserman, G.A., Fisher, P., & Lucas, C.P. (2007) Diagnostic screening with incarcerated youth: comparing the DPS and Voice DISC, Criminal Justice and Behavior, 34(6); 830-845.

In the first examination in a juvenile justice setting, associations between the DISC Predictive Scales (DPS) and the Voice Diagnostic Interview Schedule for Children in identifying mental health concerns were investigated. Assessment center youth (N = 195) completed computerized versions of both instruments. Psychometric properties and logistic regression estimates for diagnostic clusters were examined, and DPS summary subscales to derive cut points for incarcerated youths were created. DPS consistently identified higher percentages of youths. At the cluster level, there was considerable concordance, with agreement higher for the same diagnostic constructs, even after statistical adjustment. Summary subscale cut points identified ≥ 82% of disordered youths. Given recommendations for universal screening in corrections, the DPS offers advantages over existing screens as a component of mental health assessment.

McReynolds LS and Wasserman GA. (2006). Suicide risk at juvenile probation intake. Suicide and Life-Threatening Behavior, Vol.36(2):230-249.

This paper measured suicidal behavior and disorder on the DISC in 991 randomly selected youths, and examined associations between demographic, offense, and disorder characteristics and past attempts. Recent attempts were more common in girls, in those with Depression or SUD, and in violent offenders. While more girls reported recent attempts regardless of depression, depressed boys’ attempt risk was as high as girls’. Depression contributed more to attempt history than did SUD.

Cuellar AE, McReynolds LS, Wasserman GA. (2006). Can mental health treatment reduce crime among youth? Journal of Policy Analysis and Management, Vol.25(1):197-214.

This study considers the policy issues around youth mental health diversion programs and evaluates the effect of a mental health diversion program for youth that was implemented in Texas. Mental health diversion can be used effectively to delay or prevent youth recidivism.

Hayes M, McReynolds LS, Wasserman GA, Haxton W (2005). Comparison of the MAYSI-2’s Paper and Voice Formats. Assessment, Vol.12(5):395-403.

This paper examined the comparability of paper and voice formats of the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) among incarcerated youth. The findings suggest that the two formats of the MAYSI-2 are comparable instruments. The voice format may be preferable to the paper format for screening justice youth for mental health problems as it may reduce incomplete data, may increase reporting of stigmatized behaviors, and its ability to automatically generate scored reports and aggregate data.

Wasserman GA, Mc Reynolds, LS, Fisher, PA, Lucas, CP (2005). Diagnostic Interview Schedule for Children: Present State Vocie Version (Voice DISC). Chapter in : Handbook of Screening and Assessment Tools for Juveniles Justice, Eds. Grisso T, Vincent G, Seagrave D. New York: Guilford Press.

Wasserman GA, Vilhauer JS, McReynolds LS, Shoai R, John R (2005). Mental Health Screening in the Juvenile justice System: A comparison between the Voice-DISC-IV and the MAYSI-2. Journal for Juvenile Justice and Detention Services 19 (1).

This paper summarizes previous findings of Wasserman et al., 2004, which examined associations between the MAYSI-2 and DISC-IV to determine the degree to which they identify justice youths with mental health service needs. MAYSI-2 identified youths with some DISC-IV disorder, but did not discriminate well between specific disorder types. MAYSI-2 identified youths with a history of suicide attempts and was more likely to identify youths with comorbid disorders than those with non-comorbid disorders. Results support existing practice recommendations for two distinct screening procedures to identify emergent risk and service need. Clinical implications for the screening of incarcerated youths are discussed.

Wasserman GA, McReynolds LS, Ko SJ, Katz LM, Schwank J (2005). Gender differences in psychiatric disorder for youths in juvenile probations. American Journal of Public Health, 95 (1), 131-137.

This study examined gender differences in psychiatric disorder among youths at probation intake. Girls with violent offenses, compared to other groups, were three to five times more likely than boys to report anxiety disorders. Among youths with conduct problems, girls demonstrate elevated risk for internalizing disorder, compared to boys.

Ko SJ, Wasserman GA, McReynolds LS, and Katz, LM (2004). Contribution of parent report to Voice DISC-IV diagnosis among incarcerated youth. Journal of the American Academy of Child and Adolescent Psychiatry,43 (7) 868-877.

We examined contribution of parent report to youth report in defining psychiatric caseness among incarcerated youths. We found that parent report potentially adds new information for youths who do not endorse any impairment or deny disorder. However, the value of including parent report for youths in justice settings should be balanced with the real challenges involved in obtaining information from parents.

Vilhauer JS, Mc Reynolds LS, Wasserman G, Wahl R (2004). Probation Officer's Mental Health Knowledge and Practices. Perspectives, 28 (3), 28-31.

This study examined probation officer's responses to a survey on mental health knowledge and practices in their employment settings when working with justice youth who have mental health concerns. We found that probation staff do play an important part in the early identification of juveniles with mental health problems and linking them to services. There are gaps, however, between existing practice and current knowledge about mental disorders, assessment and appropriate treatments. Fortunately, most probation officers indicate a desire to increase their knowledge in these areas. Training curricula and materials need to be developed that are specifically tailored for the role of the probation officer to facilitate linking youth to mental health services.

Wasserman GA, McReynolds LS, Ko SJ, Katz LM, Cauffman E, Haxton W, and Lucas CP (2004). Screening for emergent risk and service needs among incarcerated youth: Comparing MAYSI-2 and Voice DISC-IV. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 629-639.

In this study we examined the associations between the Massachusetts Youth Screening Instrument-Second Version (MAYSI-2) and the Voice DISC, and the extent to which they overlap in identifying youths with mental health concerns. We found that the MAYSI-2 identifies some DISC-IV disorders better than it identifies others. Lack of overlap may result from MAYSI-2's combining diagnostic constructs into single subscales. In systems with multiple avenues of referral, the MAYSI-2 is a useful intake screen, but its utility as the sole means for identifying diagnoses for treatment purposes is limited.

Wasserman GA, Jensen PJ, Ko SJ, Cocozza JJ, Trupin EW, Angold A, Cauffman E, Grisso T (2003). Mental health assessments in juvenile justice: Report on the consensus conference. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 753-761.

This article reports on a Consensus Conference which was sponsored by the Center for the Promotion for Mental Health in Juvenile Justice, the Center for the Advancement of Children's Mental Health (both at Columbia University), and the National Center for Mental Health in Juvenile Justice in April 2002. A national group of expert researchers and practitioners convened and ultimately, agreed upon six recommendations for mental health assessment which include explicit information about how, why, and when to obtain mental health information on justice youth at each important step in the process.

Wasserman GA, McReynolds LS, Lucas C, Fisher P, and Santos L (2002). The Voice DISC IV with incarcerated youth: Prevalence of disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 41(3), 314-321.

This paper reports on rates of psychiatric disorder among incarcerated male juveniles, and the feasibility of using a self-administered, comprehensive structured psychiatric assessment (i.e., Voice DISC) with those youth. Rates of disorder were comparable to prior diagnostic assessment studies that were conducted using a face-to-face interview. Beyond expectably high rates of disruptive and substance use disorders, youth reported high levels of anxiety and mood disorders, with over 3% reporting a past month suicide attempt. Youth incarcerated for substance offenses reported Substance Use Disorders.

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