Our recommendations for best practices for screening and assessing youth in the juvenile justice system emerge from a Consensus Conference we hosted in April 2002. They are fully described in our paper published in the July 2003 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. The recommendations have been endorsed by the American Probation and Parole Association, the National Mental Health Association, and the National Alliance for the Mentally Ill.

A national group of expert researchers and practitioners derived six recommendations, following the expert consensus method. Experts had broad experience creating collaborations between juvenile justice, mental health, and child welfare systems, and they understood the policy implications of conducting such assessments in juvenile justice settings.

The experts agreed upon the following recommendations, targeted for use by administrators and directors of juvenile justice facilities and their clinical staff.

Recommendation 1: Emergent Risk

Provide an evidence-based, scientifically sound mental health screen within the first 24 hours of a youth’s arrival at a facility.

An evidence-based, scientifically sound mental health screening should be included in the general health screen. While addressing legal protections for the youth, screening should attend to current use of any medications, service/treatment history, current substance use, and risk of suicidal, self-injurious, and assault behavior.

Recommendation 2: Mental Health Service Needs

Provide an evidence-based, scientifically sound mental health screening and/or assessment for all youth as early as possible in order to determine need for mental health services.

This comprehensive mental health assessment should occur prior to disposition to inform judicial and probation planning. Because mental health conditions may contribute to misbehavior, treatment may help prevent re-contact with the justice system. Because of the potential overlap between mental health conditions and criminal activity, screening and assessment must incorporate legal protections for youth. Youths screening positive should receive comprehensive mental health assessments.

Recommendation 3: Mental Health Assessment Components

A comprehensive mental health assessment must be based upon careful review of information from multiple sources and must measure a range of mental health concerns.

The major Axis I psychiatric disorders, suicidality, and the youth’s functioning and impairment at home and in school are all important to measure. Assessment should be multifaceted and consist of direct observation, face-to-face interview, mental status examination, chart review, interview with parents/other adults, and family history.

Recommendation 4: Community Re-entry

Provide an evidence-based and scientifically-sound screening or assessment for all youth preparing to leave a post-adjudicatory secure facility and return to their communities.

In order to facilitate linkage to community mental health services, high risk youths should receive a comprehensive assessment, and low risk youths should receive a screen to identify any mental health concerns before release. Youths who screen positive should receive a full mental health assessment.

Recommendation 5: Re-Assessment

Provide evidence-based, scientifically sound screening/assessment on a regular basis for all youth.

Certain components of mental health status are likely to change over time in response to internal and external events. While the exact timing and interval for mental health screening and assessment may vary, at a minimum it should be a part of any routine medical screening and/or assessment. Youth who screen positive should receive a full mental health assessment.

Recommendation 6: Staff Training

Ensure that mental health staff are professionally credentialed, or directly supervised by credentialed staff. Provide training for staff appropriate to their role for assessment in evidence-based, scientifically sound mental health screening/assessment procedures.

Staff at a variety of levels need to be able to assist with assessing youth’s risk to self and others, so that they will be able to inform treatment and service planning/disposition for the youth.