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Gepubliceerd in: Journal of Youth and Adolescence 7/2017

24-09-2016 | Empirical Research

Racial/Ethnic Disproportionality in Psychiatric Diagnoses and Treatment in a Sample of Serious Juvenile Offenders

Auteurs: Michael T. Baglivio, Kevin T. Wolff, Alex R. Piquero, Mark A. Greenwald, Nathan Epps

Gepubliceerd in: Journal of Youth and Adolescence | Uitgave 7/2017

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Abstract

Psychiatric disorder prevalence has been shown demonstrably higher among justice-involved adolescents than youth in the general population. Yet, among arrested juveniles, little is known regarding racial/ethnic differences in disorder prevalence, the role of trauma exposure in the diagnosis of behavioral disorders, or subsequent psychiatric treatment provided to adolescents with such diagnoses. The current study examines racial/ethnic disparity in psychiatric diagnoses and treatment of behavioral disorders associated with delinquency, controlling for traumatic experiences, behavioral indicators, and prior offending among serious juvenile offenders. Logistic regression is employed to explore the racial/ethnic disproportionality in behavioral disorder diagnoses and psychiatric treatment provision among 8763 males (57.7 % Black, 11.8 % Hispanic) and 1,347 females (53.7 % Black, 7.6 % Hispanic) admitted to long-term juvenile justice residential placements in Florida. The results indicate Black males are 40 % more likely, and Black females 54 % more likely to be diagnosed with conduct disorder than Whites, even upon considerations of trauma, behavioral indicators, and criminal offending. Black and Hispanic males are approximately 40 % less likely to be diagnosed with ADHD than White males, with no racial/ethnic differences for females. Importantly, Black males are 32 % less likely to receive psychiatric treatment than White males, with no differences between White and Hispanic males, or any female subgroups. Traumatic exposures increased the odds of oppositional defiant disorder and ADHD, but not conduct disorder for males, though adverse childhood experiences were unrelated to behavioral disorder diagnoses among females.
Voetnoten
1
10,218 youth were admitted to residential programs in Florida during the December 1, 2011 through December 1, 2014 study time frame. Eighty-two of the 10,218 youth (0.8 %) were not assessed with the full community version risk/needs assessment and residential version risk/needs assessment. Sixty-two of the 82 youth were not assessed with a residential version assessment because the residential version was not required as of the date of the end of the study period (December 1, 2014). Youth admitted to a residential program are required to be assessed within the first 30 days of admission; the 62 youth had not been at the residential program for 30 days by the end of the study period. The 20 youth not assessed with a full community version prior to placement were assessed with a pre-screen community version, which does not contain the required information to create an ACE score. The pre-screen assessment-only admissions were most likely violations of Florida Department of Juvenile Justice protocol by probation staff. As the current study focuses on racial/ethnic differences, the 26 “other” youth were excluded as sample sizes were too small for valid comparisons.
 
2
The full community version risk/needs assessment consists of 126 items across the following twelve domains: criminal history, school, leisure/free time, employment, relationships, family/living situation, alcohol/drug use, mental health, attitudes/behaviors, aggression, and social skills. Current Florida Department of Juvenile Justice policy requires each youth being considered for residential placement to receive a full community version risk/needs assessment prior to admission to such a program.
 
3
In Florida, only a judge can order placement of a youth in a Florida Department of Juvenile Justice residential program. All youth placed in such programs are administered the community version risk assessment described above and are also evaluated by a licensed mental health professional. The youth are placed at the residential programs for an indeterminate period of time, with release (approved by the judge) based on completion of an individualized performance/treatment plan, rather than a set length of stay. The performance/treatment plans contain goals that address the youth’s specific risk factors as per the risk assessment and the comprehensive evaluation conducted by the licensed mental health professional. All youth who have not obtained a high school or equivalent diploma must attend school 25 h per week, instructed by certified Florida teachers. Youth attend treatment groups and individual counseling sessions (provided by licensed or supervised therapists) based on their individualized needs. Group services predominantly include cognitive behavioral interventions (to address criminal thinking/thinking errors), skills training groups, substance abuse prevention or intervention (based on the youth’s substance use history and/or diagnoses), sex offender services (based primarily on offending history), mental health group services (such as healthy relationships, identifying internal and external triggers, anger management), and family therapy. All residential programs have a behavior management system (token economy) which requires level attainment for increased privileges.
 
4
Comprehensive mental health evaluations are governed by Florida Statute (F.S. 985.29) and must include the following components: identifying information; reason for evaluation; relevant background information (including home environment/family functioning; history of physical abuse, sexual abuse, neglect, witnessing violence and other forms of trauma; behavioral functioning; health [physical health, mental health and substance abuse] and educational functioning); behavioral observations/mental status examination; interview or procedures administered; discussion of findings; diagnostic impression/formulation; and recommendations. The current study does not include analyses of disparities across evaluator credentials (e.g., licensed social worker, licensed psychologist, etc.), or psychiatric diagnosis assessment methods, as the purpose was to examine differences in the diagnoses youth were labeled with upon admission to residential placement, and not the means by which such disparities arose. Future work would benefit from detailed examination across such evaluation and evaluator characteristics.
 
5
Of note, as per Florida Department of Juvenile Justice protocol, Hispanic ethnicity supersedes race, meaning the Black youth are non-Hispanic Blacks, and the White youth are non-Hispanic Whites.
 
6
While an anonymous reviewer questioned our use of impulsivity as a covariate in light of its association with one of the dependent measures (ADHD), we argue for its inclusion as: (1) impulsivity is only one component of ADHD; (2) our measure of impulsivity assesses such behavior within the past four weeks, while the ADHD diagnosis requires six months of such behavior; and (3) traumatic stress/exposure has been implicated in changes in brain functioning which alter the “fight or flight” response and increasing the propensity to perceive situations as overly threatening than reality suggests and act impulsively (Kerig and Becker 2010).
 
7
Specifically, males were significantly more likely than females to be Black or Hispanic, have more prior felonies, more likely to have sexual felony offenses, learning needs, self-report gang membership, and more likely to accept responsibility for actions. Males were less likely than females to have alcohol problems, had fewer prior misdemeanors, fewer prior detention stays, were younger at age of first suspension/expulsion from school, less likely to have extensive runaway history, had lower ACE scores and less likely to have child welfare history, less likely to have had a family member killed as a result of violence, less likely to be transient/homeless, less likely to have attempted suicide or engage in self-mutilation, less impulsive and less likely to espouse belief in the appropriateness of verbal or physical aggression.
 
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Metagegevens
Titel
Racial/Ethnic Disproportionality in Psychiatric Diagnoses and Treatment in a Sample of Serious Juvenile Offenders
Auteurs
Michael T. Baglivio
Kevin T. Wolff
Alex R. Piquero
Mark A. Greenwald
Nathan Epps
Publicatiedatum
24-09-2016
Uitgeverij
Springer US
Gepubliceerd in
Journal of Youth and Adolescence / Uitgave 7/2017
Print ISSN: 0047-2891
Elektronisch ISSN: 1573-6601
DOI
https://doi.org/10.1007/s10964-016-0573-4