Criminal Justice Policy Review

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A Qualitative Examination of Juvenile Probation Officers as Gateway Providers to Mental Health Care Evan D. Holloway, James R. Brown, Philip D. Suman and Matthew C. Aalsma Criminal Justice Policy Review published online 25 March 2012 DOI: 10.1177/0887403412436603 The online version of this article can be found at: http://cjp.sagepub.com/content/early/2012/02/09/0887403412436603

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436603 olloway et al.Criminal Justice Policy Review

CJPXXX10.1177/0887403412436603H

A Qualitative Examination of Juvenile Probation Officers as Gateway Providers to Mental Health Care

Criminal Justice Policy Review XX(X) 1–23 © 2012 SAGE Publications Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0887403412436603 http://cjp.sagepub.com

Evan D. Holloway1, James R. Brown2, Philip D. Suman1, and Matthew C. Aalsma1

Abstract Despite significant rates of psychopathology, less than 10% of court-involved youth are connected to appropriate care on release from detention. The majority are mandated to probation on release, providing the juvenile probation officer (PO) a unique opportunity to facilitate connection to mental health care. The current study supported this notion through analysis of qualitative interviews with recently detained youth, and their caregivers, who were identified with mental health concerns in detention. The juvenile PO was evaluated as a gateway provider (GP) in the pathway to mental health care. Results supported previous research discussing the conflicting roles inherent in juvenile probation: law enforcement and rehabilitation. A number of individualand system-level factors specific to juvenile POs improved or impaired likelihood of connection to care. Further research should investigate how the interaction of the individual juvenile PO’s law enforcement orientation, and departmental culture and climate, affects youth’s connection to mental health care. Keywords adolescence, juvenile justice, probation, reentry, treatment

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Indiana University School of Medicine, Indianapolis, IN, USA University of Wisconsin, Oshkosh, WI, USA

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Corresponding Author: Matthew C. Aalsma, Section of Adolescent Medicine, Indiana University School of Medicine, Health Information and Translational Sciences (HITS) Building, 410 West 10th Street, Room No. 1001, Indianapolis, IN 46202, USA Email: [email protected]


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Criminal Justice Policy Review XX(X)

Court-involved youth experience mental health problems at a high rate. Such high rates of psychopathology are evidenced among detained youth (Fazel, Doll, & Långström, 2008; Grisso, Barnum, Fletcher, Cauffman, & Peuschold, 2001). Epidemiological studies among detained and incarcerated youth suggest that over half have a diagnosable mental illness (Fazel et al., 2008). Even with such significant mental health rates, youth in juvenile justice demonstrate low rates of mental health utilization; less than 10% of detained and incarcerated youth receive mental health referrals or treatment on community reentry (Rogers, Zima, Powell, & Pumariega, 2001; Teplin, Abram, McClelland, Washburn, & Pikus, 2005), suggesting very low rates of service engagement. Such a lack of connection to care warrants further investigation of ways to connect this high-needs population to appropriate care. One way to understand youth connection to care is the gateway provider (GP) model (Stiffman, Pescosolido, & Cabassa, 2004) which examines the influential role of adults in improving adolescent’s ability to access services. The majority of court-involved youth are mandated to probation on community reentry (Snyder & Sickmund, 2006). A unique opportunity to serve as a GP to mental health care is imparted to the juvenile PO. We will examine the juvenile PO’s role in connection to care through the lens of the GP Model. Juvenile POs’ actual day-to-day activities have been broadly organized into three categories: intake screening and assessment, presentence investigations, and supervision (Corbett, 1999; Leifker & Sample, 2010; Torbet, 1997). Inherent in these duties are the competing, and sometimes conflicting, mandates of rehabilitation and law enforcement (Blake, 1948; Clear & Latessa, 1993; Dembo, 1972; Meeker, 1948; Ohlin, Piven, & Pappenfort, 1956; Steiner, Purkiss, Kifer, Roberts, & Hemmens, 2004). There has been much discussion over the last 50 years about these conflicting mandates and how the mandates affect the PO–client relationship, and subsequently, outcomes for that client. Blake and Meeker wrote dueling opinion pieces as early as 1948, arguing the pros and cons of probation as “casework,” a term which refers to the social work profession (Blake, 1948; Meeker, 1948). Ohlin and colleagues (1956) noted the increase in social work educated POs after World War II and underscored that social workers who worked in the probation/parole field not only were viewed as outsiders but also were not receiving the “educational and organizational support accorded to other fields of service in [social work].” Others went so far as to propose the “complete elimination of probation supervision” (p. 29) while restructuring the probation field toward an investigatory arm of the court because the profession’s conflicting goals rendered it ineffective (Rosecrance, 1986). Thus, for decades, POs had to internally manage the dual roles of law enforcement and rehabilitation when working with their clients. Law enforcement and punishment have been increasingly emphasized over the last 30 years as a result of rising rates of juvenile crime (Hinton, Sims, Adams, & West, 2007). This notion is further supported by a recent analysis of state codes regarding juvenile POs’ legally prescribed functions which evidenced significant variation between ascribed law enforcement and rehabilitation tasks; specifically, 45 states


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assigned more than double the amount of law enforcement tasks than rehabilitation tasks to juvenile POs (Steiner et al., 2004). In sum, juvenile POs perform both law enforcement and rehabilitative functions, and although some state-by-state variation exists, legislation appears to favor law enforcement strategies over rehabilitation. Youth are generally not likely to seek mental health care or treatment on their own, and in the event that they are connected to care, they have likely been aided by an adult who serves as a “gateway” (Alegria et al., 1991; Bickman, Heflinger, Northrup, Sonnichsen, & Schilling, 1998). As youth are unlikely to seek help on their own (p. 190), the GP’s role of “initiat[ing] or direct[ing] the trajectory of treatment” (Stiffman et al., 2004, p. 192) is critical to the initiation of services. GPs can be informal: family friend, neighbor, or godparent, or formal: an individual embedded in the social services infrastructure. Formal examples include teachers, nurses, and of interest in the current article, the juvenile PO. GPs who are integrated into a youth’s social network, such as a family member, are more influential in this process than GPs removed from the social network (Stiffman et al., 2004). Likewise, a PO who is in regular contact with a youth will likely have more sway than a medical doctor who sees that youth for annual checkups, underscoring the relational aspect of the GP model. GPs’ “knowledge and awareness” of a youth’s service history and symptomology uniquely empowers them to recommend accurate and appropriate services for that youth (Costello et al., 1988; Stiffman et al., 2000, 2004). However, a number of individual and systemic factors improve or impair the likelihood that the PO will connect their client to services. For instance, individual factors such as the providers’ opinion of mental health and familiarity with community resources were significant predictors of connection to care for youth (Stiffman et al., 2004). In addition, systemic burdens such as increased provider caseload predicted a decrease in referrals for mental health care (Stiffman et al., 2004).

Juvenile Probation Officer as Gateway Provider A number of PO-specific factors may explain variability in their effectiveness as a GP to care. In a chart review of case files, POs suspected mental health problems for 40% of those adolescent clients referred to care (Wasserman et al., 2008). This figure contrasts a previous finding that formal GPs, of any variety, suspected 15% of clients may have mental health concerns (Stiffman et al., 2004); POs may be more likely than other formal GPs to perceive their adolescent clients as having mental health concerns. POs’ increased awareness of mental health is consistent with the literature reporting elevated prevalence of mental health diagnoses with court-involved youth (Fazel et al., 2008). Although POs may be more sensitized to mental health needs than other GPs due to working with a high-risk population, they may be less sensitive to specific subtypes of mental health. For instance, internalizing disorders were suspected with only 5% of POs’ clients, starkly contrasted with formal screening data indicating that over 20% of


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juvenile-justice-involved youth reported either anxiety or mood disorder (Wasserman et al., 2008). Differential awareness of the presence of mental health disorders indicates that although POs may be more likely than other GPs to suspect a need for mental health services, they may be less likely to suspect internalizing disorders than externalizing disorders for their clients. The disparity between perceived and actual prevalence of internalizing disorders with youth may lead to POs’ under provision of appropriate referral to mental health care. This further highlights the unique role that POs play in connection to appropriate care.

Application of the Gateway Provider Model to the Current Study As noted above, court-involved youth experience high rates of mental illness (Fazel et al., 2008). Moreover, youths in juvenile justice experience low mental health care utilization rates on community reentry (Teplin et al., 2005). Hence, facilitating entry into care is particularly important for recently detained youths who are active in probation with identified mental health concerns (i.e., the current study population). A GP is an adult who aids in the initiation of treatment (Stiffman et al., 2004). As such, we investigated the perception of juvenile PO characteristics and how client interactions affected the motivation or ability of youth and their caregivers to engage in mental health care treatment. We hypothesized that POs who served as a GP would not only “initiate or direct” treatment but also assist the family in achievement of stated goals, which could be personal and/or court ordered. The unique role of the juvenile PO in this process has not been fully addressed in the literature. More specifically, the PO as a GP to care has not been evaluated from a client- or family-based perspective. Srebnik and Cauce (1996) suggest that help-seeking pathways and service utilization for youth with mental health issues should be examined not only quantitatively but also qualitatively so as to “obtain a richer understanding” of “network variables” (p. 217). As such, qualitative methodology was chosen to examine the role of the juvenile PO as a service provider in the pathway to care.

Method Participant Recruitment A statewide initiative to begin mental health screening in juvenile detention centers formed the basis for study recruitment. The instrument chosen, Massachusetts Youth Screening Inventory (MAYSI-2), is a validated juvenile screening measure for mental illness (Grisso et al., 2001; Wasserman et al., 2003). To participate, county sites from a Midwestern U.S. State agreed to follow specific protocols to screen all detained youth for mental illness; successful implementation of systems for screening and referral for mental health was well in place for almost 2 years. Of those counties meeting these criteria, we chose four separate county detention centers from


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the state’s northern, central, and southern geographical regions with equal representation of both urban and rural areas. Participant recruitment was based on purposeful, criterion-based sample methods (Patton, 2002). Inclusion criteria were detained youth who (a) scored above the cutoff threshold on their initial mental health screen, (b) were released back to their home, (c) were released for a minimum of 30 days, (d) were between 11 and 17 years of age, and (e) had at least one caregiver (parent, grandparent, or legal guardian) who agreed to be simultaneously interviewed. Detention center staff called parents and read them a script describing the study. Parents were then asked if they would be interested in receiving a call from a member of the research team for additional information. Initial contact was handled by detention center staff rather than researchers in an effort to minimize coercion. The research team initially proposed to have a member of the research team call prospective participant families. Members of the Institutional Review Board (IRB) were of the opinion that having research personnel contact families was problematic as results of the mental health screening tool would be accessed. In response to this concern, the research team amended the recruitment protocol so that detention center staff would contact those who (a) scored above the cutoff on the MAYSI and (b) were released to their homes. IRB training on research ethics, which included coercion, was administered to each detention center supervisor. If parents/guardians communicated an interest in participating, a member of the research team contacted them to answer any questions/ concerns and schedule an appointment. The study was approved by the Indiana University Institutional Review Board.

Interviews The interviews for this study were conducted from December 2009 to April 2010. Although 54 youth and parents initially agreed to be interviewed, no-shows and cancelations resulted in a total of 38 participants (19 parents and 19 youth). Participants were given three options of where to meet: (a) at their home, (b) in a private room within a public library, or (c) at the county detention center. Interviewers used parent- and youth-specific semistructured interview guides. Both interview guides were designed to gather information on the topic of facilitators and barriers to engagement in mental health care. After three initial interviews, additional questions were added, and two questions were revised for clarity. A total of 21 questions for youth (see Table 1) and 19 questions for parents (see Table 2) were used for the final semistructured interview guide. Each interview was digitally recorded, and observation notes were written during and after the interviews.

Participants Youth participants’ ages ranged from 11 to 17 with a median age of 15.5 for males and 16 for females. Seven of the males were Black, four White, and one Hispanic for a total of 12 male youth. Three of the females were Black, four were White, and none


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Table 1. Adolescent Interview Questions Tell me about what makes a teen healthy (warm-up question) Can you describe any counseling services you received before you were ever placed in detention? While in detention, were there ever opportunities or offers to have counseling services? What were your thoughts about having counseling services after leaving detention? Did you know where to go? Can you walk me through a time when you had a good experience in receiving counseling services? Can you walk me through a time when you had a bad experience in receiving counseling services? What support do you have in getting counseling services? How have your parents affected you in getting counseling services? How do your friends affect you in getting counseling services? How did your probation officer affect your experience with counseling services? Do you have any sense of how your probation officer feels about counseling? Does that impact the way you feel about counseling? I’m interested in knowing what can make it difficult for a young person to get counseling services? How did your experience in juvenile detention affect your receiving counseling services? Do you have any sense of how your probation officer feels about counseling? How does that affect you? Do you think it would be helpful to have someone to talk to? What are the reasons you do/ don’t want to? What would you tell a friend who wanted counseling services as they are preparing to leave detention to go home? Describe what a good counseling service might look like for you? What do you think of when you hear the words, “mental health?” For you, is there a difference in getting counseling services compared with getting mental health services? What were you told about the possibility of having a mental health issue? Is there anything else you would like me to know about what it’s like being you and getting counseling services?

were Hispanic for a total of seven female youth. Youth participants’ current grade ranged from 6th to 11th grade, with most attending an alternative school. Parent participants consisted of 14 mothers, 2 grandmothers, 2 fathers, and 1 mother– father pair. Eleven were White, eight were Black, and one was Native American. Eleven parents had public insurance for their youth, five had no insurance, and three had private insurance. Twelve youth were prescribed psychiatric medications whereas 11 of the 19 youth had newly received or continuing mental health services on community reentry.


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Holloway et al. Table 2. Caregiver Interview Questions

How many years have you been a parent (warm-up question)? Prior to your child entering detention, what experiences has your child had regarding counseling services? What is your impression of the counseling services that your child has received? What were your thoughts regarding your child and counseling services while he or she was detained? Before your child was released, were there any thoughts or plans regarding having him or her receive counseling services? Could you tell me your understanding of the mental health referral process to get your child services? Some time during the course of your child’s detention, did anyone talk to you about mental health services for your child? What influenced your decision to get your child mental health services? How do see the mental health system in providing services to your youth? What was your sense of how your youth’s probation officer felt about counseling? How does that affect you? What obstacles or barriers have you experienced when wanting your child to receive mental health services? Obstacles or barriers in your child continuing with mental health services? Were there resources that provided access to your child receiving mental health services? Was there ever a time someone shared a mental health diagnosis regarding your youth with you? Can you describe your understanding of any mental health diagnosis that your child may have been given? What concerns you most about your child and the mental health system? What do you think of when you hear the word, “mental health?” If you knew a parent who had a child coming out of detention who was wondering about mental health services for their child, what would you want to tell them? What would a counseling service have to have in order for your youth to be positive toward receiving the service? Is there anything else you would like for me to know about what it’s like being you and getting counseling services?

Data Collection Three doctoral-level, social science researchers experienced in qualitative interviewing conducted the semistructured interviews. Youth and their parents were interviewed separately, with interviews ranging from 6 to 39 min for youth (M = 21.74, SD = 8.54) and 17 to 51 min for caregivers (M = 31.68, SD = 10.19). A US$20 gift card was given to both parent and youth at the conclusion of each interview.

Analysis and Interpretation Our goal was to develop a model to understand the internal and external processes youth and parents experienced in connecting to mental health care. Data collection and analysis were performed using a grounded theory approach (Creswell, 2007).


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Table 3. Juvenile Probation Officer Orientation Tensions Law enforcement

Rehabilitative

Punitive Exasperation/stubbornness Lack of follow-through

Genuinely caring Flexibility Coordination

This approach was employed in combination with the constant comparative method (i.e., comparing incidents, events, and activities to emerging categories; Mays & Pope, 2000). Team members initially developed categories they believed would emerge from the data through open coding, which occurred when reading three parent and three youth transcripts individually. After individual reading, the analysis team reviewed the same interview transcripts and agreed on initial categories. Team members then used a combination of open and axial coding called microanalysis, a line by line analysis to generate any additional codes (Patton, 2002). Finally, codes and categories were placed into NVivo 8 software (QSR, 2008). All of the transcripts were recoded in NVivo into the new categories. Individual annotations were made in each transcript during analysis to refer back to for discussion. Discussion and debriefing among the research team led to triangulation between parent interviews, youth interviews, and coders when transcripts were analyzed and compared between team members (Guba, 1981). Emerging themes were identified as being either constructive or detrimental to achieving the participants’ goals: (a) compliance with court-ordered directives, (b) progress toward termination of court-involvement, and (c) connection to mental health care. These goals were found to center greatly around the juvenile PO. Perceived PO characteristics were found to align quite well with the emergent themes as either being conducive toward or against the achievement of the aforementioned participant goals.

Results A number of themes from caregivers and youth describing POs were identified. These themes were aligned with one of the juvenile PO’s conflicting law enforcement and rehabilitative functions. These conflicting orientations affected the youth’s ability to achieve their goals. These goals were (a) compliance with court-ordered directives, (b) progress toward termination of court involvement, and (c) connection to mental health care. The themes and the respective orientations with which they were aligned are included in Table 3. Participants described a great deal of variation in the PO’s perceived attitudes toward their clients, with reports of POs who were either focused on “punishment” or “genuinely caring.” Such variation in PO orientation affected participants’ motivation, ability to utilize mental health care, and ability to comply with court and PO directives. PO individual orientations are detailed below with their corresponding themes.


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“Genuinely Caring” Probation Officer One pattern that emerged with parents who described a positive experience with their PO was the perception of caring. Parents who perceived their PO as caring toward their youth and the youth’s eventual disposition had a favorable view of the relationship. In the following illustration of caring, this mother of a 15-year-old, Hispanic, male described her son’s PO in such a way: . . . [The] PO is relatively new to the office, but she is honestly, a genuinely caring individual. Some POs are just prior police that, you know that private punishment kind of an attitude, where she seems more like a counselor. There’s a stark difference between the two, definitely. The perceptual difference between a “punishment” attitude and a “genuinely caring” one provides a “stark difference” for the parent. One way caring was demonstrated by POs was their ability to respond dynamically to different circumstances. For instance, this mother of a 16-year-old, Black, male acknowledges that their PO “shows love” and has shown, when needed, the ability to give good advice while providing encouragement when her child is doing well: Mother: I love her probation officer . . . . She cares. She shows that she cares. Interviewer: How does she show she cares? Mother: By her conversations, the way she greets the parent and the child, and the conversation she has with the parent and the child. She shows love through conversation. She gives good advice to the child that’s in trouble to try to get them on the right track. She uplifts them when they’re doing good. This mother recognizes that this PO will be there when her child is “in trouble” as well as when he’s “doing good.” Hence, being a “caring” PO and showing positive regard for youth in difficult situations make families feel as if they are receiving support. This perception from parents communicated a PO’s willingness to work through problems as they arose.

The Punitive Probation Officer Several participants provided accounts of POs they perceived as being negative toward the youth. Such negativity led the parent and youth to perceive the PO as punitive or threatening. This 15-year-old, Hispanic, male described an adversarial relationship with his PO: Youth: I don’t know if she has any personal feelings toward it like if she likes it or not [mental health]. I just know she likes to use it as a threat . . . if she feels that you’re doing anything that doesn’t make her happy she’ll basically sit you down and she’ll give you a little pamphlet and you look at it, and it basically


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explains all the hours that you’ll have to be at this counseling place and she’ll be like, “screw up again and that’s what you get.” So she uses it as a, “get on my bad side, you’re going to be unhappy.” In this case, mental health and counseling services are used as a threat. The threat being that if you are on the PO’s “bad side,” punishment of services unrelated to pertinent issues will be mandated. Furthermore, mental health services have been framed in a negative light rather than as an aid for this adolescent. Other experiences led parents to perceive their youth’s POs as uncaring. This mother illustrates that her 16-year-old, Black, son’s PO didn’t want him to be in the community: Mother: . . . she [PO] just wanted him locked up, period. She was saying, like, “Oh, he shouldn’t be out—he should just be locked up.” That why I was saying, well, he doesn’t sell drugs, he doesn’t shoot people, he doesn’t have a gun, he goes to school. Interviewer: Did she tell you why she felt like he should be locked up? Mother: Because—basically because of his record. The mother’s perception was that the PO did not want to help keep her son in the community due to his previous charges. This PO came across to the parent as unmotivated and unwilling to pursue positive outcomes “because of his [the client’s] record.” In addition, the PO emphasized punishment by leveraging a recommendation of incarceration. In failing to discuss possible counseling services with the parent, the PO communicated that she expected failure: . . . ‘cause she was saying he will be locked up, even if he wasn’t—if he didn’t go to [Residential Treatment Facility], he would go to Boy’s School [State Juvenile Prison] . . . he would stay there until he completed the program. So that could have been two months, a month or a year. The mother exhibits her desire to keep her son engaged in mental health services: Interviewer: So you’ve done [Community Mental Health Center (CMHC) 1], [CMHC 2], [CMHC 3], [Wraparound services], any other programs? Mother: He did the [Mental Health programming], we did [Family Support Program], this—that’s the third rated, that’s the thing that we used to do once a year. They would do a follow-up with us. [Hospital name], he went to school there for the day treatment program. We’ve been through a lot of places. Despite this mother’s focus on obtaining mental health services for her son, she perceives the PO as believing that her son should be removed from the community due to his previous charges and past involvement with mental health. The PO has shown no interest in the continuation of services despite the family’s continual effort to access


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them. Mental health services provide this mother with hope while the PO sees previous service engagement as ineffective. As a result of this attitudinal disparity, the parent perceives a misalignment between her goals and those of the PO, which serves to obstruct any further coordination. Participants described variability in PO’s attitudes, as well as PO reactions to adverse situations and flexibility in their working relationship. These themes were aligned with one of the conflicting mandates of juvenile POs: law enforcement versus rehabilitation. POs becoming exasperated in the midst of adversity or being stubborn were themes associated more with a law enforcement orientation, whereas flexibility seemed to be related to a rehabilitative orientation.

Probation Officer Exasperation/Stubbornness One theme related to PO interaction described by parents was that of the potential trouble leading to PO exasperation. Exasperation sometimes led to POs disconnecting from their clients. In this example, the mother of a 16-year-old, White, female describes the PO’s exasperation as not “want[ing] to deal with her [daughter]”: Interviewer: How do you think she felt about counseling, getting your daughter counseling? Mother: . . . When her counselor found out about this fight she was shocked because when we went in she wanted to talk to me to tell me what a great progress that had been going on at the counseling center and everything. And now her PO doesn’t even want to deal with her. Due to a fight at school, this mother perceives that the PO doesn’t want to deal with the family. Avoidance was reported when participants perceived exasperation on the part of the PO. This unwillingness to communicate was perceived as a signal that the PO may have already decided on a recommendation for incarceration. A lack of willingness by the PO to communicate with the family or other providers can disable the family in a moment of crisis while subtly de-emphasizing the importance of rehabilitation. In the following example, a grandmother describes her and her youth’s experience when the PO refuses to discuss the case with the family; resulting in the relationships turning adversarial. As a result, this grandmother perceives that the PO’s mind was already made up about her 14-year-old, Black, male grandson. Interviewer: What are your thoughts about [PO’s name], what she thinks about counseling or mental health? Does she think it’s important, not important? Grandmother: She just wants to send him to boy’s school [State Juvenile Prison]. Interviewer: So it’s something she hasn’t talked about? Grandmother: No . . . She’ll tell me, “I can’t talk to you about the case because the lawyer said I can’t talk to you about the case.” Interviewer: So she hasn’t talked about counseling or other services? Grandmother: No.


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In the previous case, beyond refusing to discuss the case with the grandmother, this PO reveals to the grandmother that she has been in contact with the prosecutor. The unwillingness to communicate signals to this family that the PO is not aligned and, therefore, against the family as a result of her collaboration with the prosecution.

Probation Officer Flexibility Court-involved youth and their families described a number of challenges in accomplishing court orders. One frequently reported challenge that emerged was the theme of flexibility when dealing with the court system. Within the court system, participants reported a variety of experiences related to PO’s flexibility, which had a profound effect on family’s interaction with the court system. This parent describes her flexibility from her 16-year-old, White, son’s PO: Mother: Well, when I say, “she helps me,” they can drop by at any time, give you a piece of paper and tell you that you’ve got 24 hours, here are the days when you can do it . . . she works with me and when I get my child support then she tells me, “Okay, we’ll schedule it for this time. Just go.” This parent shows how the PO has the power to dictate certain deadlines for clients to pay court costs, but the PO decides to be flexible with the caregiver. The PO “helps [the parent]” because she is willing to work with her around receipt of the child support check. In this example, flexibility aligns the court system with the family’s capacity to pay court costs while avoiding possible barriers, for example. the inability to pay court costs; this flexibility emphasizes a contextual approach to probation because it addresses the family’s needs. Such an approach is in contrast to the experience described by this parent of a 16-year-old, Black, male: . . . I was told to reschedule our appointment. She was, like, “I’m not going to be able to reschedule.” I’m, like, are you not even going to give me a chance to tell you why, what’s going on? Let me tell you. She’s, like, ‘I’m not going to be able to reschedule that appointment.’ I was like, well, okay, then. I just going to go to court and tell the judge she didn’t want to reschedule my appointment, I had to reschedule, so at least they were—just hold on and she put me on hold for a few minutes, then she came back to the phone, she’s going, ‘Why don’t you just—you can come in Thursday.’ I was, like, okay, thank you, but I was thinking, ‘ugh’, because it was crazy how she came on. I am thinking what is wrong with her, so I . . . was dreading going [to the appointment] because I was thinking we were going to have a bad time. This parent describes an initial inflexible experience with her youth’s PO. The parent had to mention reporting “to court and tell[ing] the judge she [PO] didn’t want to reschedule,” highlighting the relationships power disparity. As a result of this


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interaction, the mother “was dreading going” to the rescheduled appointment. This approach emphasizes the family’s unequal footing in the relationship and its vulnerability to the decision making of the PO. Although an institutional power differential exists, such an explicit exertion of power served to misalign the PO–family relationship and to deter parents from working with the court system in the future. Participants described a great deal of variability in POs’ abilities to coordinate services as well as follow through on phone calls or appointments. This variability affected the stated goals of completion of court-ordered directives, progress toward termination of court involvement, and connection to mental health care. Lack of follow-through was associated with a law enforcement orientation because these POs only initiated contact whenever trouble arose; coordination of services is more aligned with a rehabilitative perspective because it is indicative of a PO’s desire to connect a client to mental health care.

Probation Officers’ Lack of Follow-through A number of parents expressed disappointment with their PO or the court system due to a lack of follow-through, which led to alienation and a lack of progress. This parent of a 17-year-old, White, male describes her frustrating experience: Interviewer: . . . Is there anything else that you feel like we should know or anything else you want to make sure gets passed along? Mother: Maybe for the probation department to step up. When somebody calls and leaves a message, call them back. Like I said, it’s been two weeks and I’m still waiting on that phone call. She specifies one detailed message. She’s not there on Fridays. She’s in court on Tuesdays and Thursdays. This 17-year-old, Black, male describes a lack of follow-through that is not out of the ordinary: Interviewer: Was counseling or any other services court ordered for you? Youth: No, I didn’t—they didn’t assign me to go to court. I didn’t have no court date. They just let me out with a second chance, with a warning basically and from there on, they told me I had a PO, but there was never one reported for me. This mother of a 17-year-old, White, female cites systemic barriers as the reason for disconnect with her PO: Interviewer: So did you interact with the PO? Mother: Yes, as much as I could. I mean she has 250 cases. This mother’s perception is that the PO has been given too many cases and, therefore, doesn’t have enough time or energy to work with them.


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One impediment to achieving court-ordered goals was perceived disorganization. This 16-year-old, White, female youth described her experience with an “unorganized” PO: Interviewer: . . . What about your first PO? Would think they thought counseling was important? Youth: She wasn’t a very good PO to me. She’s unorganized. She didn’t have me do any sort of counseling until the end of my probation was coming up. Wait, I don’t even think she requested it. This participant’s appraisal of her PO being unorganized resulted in no connection to appropriate care. Her negative appraisal was linked to the lack of referral to mental health services; she would have liked to have received counseling services but was never referred.

Probation Officer as Coordinator In contrast to the previously described accounts, some families described a PO who was not only flexible with them but also would coordinate services on their behalf. Service coordination most commonly denoted POs setting up an appointment and/or identifying a resource for the family. Not all families in the sample needed a referral; however, those new to mental health often expressed uncertainty about how to find a mental health care provider. In the following case, this parent of a 16-year-old, White, female describes that their PO found a counseling service for the family that the parent was satisfied with: Mother: We talked to the—I got her the counseling for free at [mental health center] and she talked to them for a while. And then all the others I just—we didn’t go through with it because her PO said he was going to get her a counselor that . . . Interviewer: So the PO was a resource? Mother: Yes, he was a very good resource. He’s the one that got that for me. The PO’s familiarity with community resources enabled him to refer his client to a counseling service, thus acting as a GP for the family. In the following case, the parent of a 16-year-old, Black, female describes her experience with their assigned PO: Interviewer: . . . How did your PO feel about counseling? Mother: She thought it would be good for [adolescent participant’s name] . . . She’s helping me with getting her back into [CMHC name]. Whereas some POs may verbally express support for mental health services, this PO exhibits her support by actively assisting the parent in coordinating services. The


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mother goes on to identify some of the difficulties facing families in identifying resources: Interviewer: Were there resources that made access to your child receiving mental health services? Were there any resources? Mother: I got my resources through her PO, but as far as like looking in the phonebook because everyone doesn’t have a computer. If we had a computer it would be better access for resources, but like in the telephone books, no, there’s not a good resources there. So unless you have a referral, you’re going to be going on a goose hunt. Unless you know somebody who knows somebody who knows something about a program or something it’s not out there like it should be. In effect, if it weren’t for the PO taking initiative and setting up an initial appointment, this parent isn’t sure if the family would have had access to resources; “it’s not out there like it should be.” She cites socioeconomic disadvantages, such as not having a computer, which can impede a family from access to services. In addition, lack of a referral can send a parent “on a goose hunt” in looking through a phonebook. Otherwise, you must “know somebody who knows somebody who knows something about a program” to find appropriate services. Such a potentially frustrating and difficult scenario was circumvented by her PO’s taking of initiative. Overall, POs’ facilitation of services and guidance for parents were associated with gratefulness. These small acts seemed to communicate a caring partnership from the PO to the parent. A number of parent participants expressed satisfaction with their POs due to their initiation of regular involvement between PO and family. Although there were families who avoided interaction with their POs, these parents reported the opposite; when their assigned PO checked in with them or their child, they were comforted. This parent of a 13-year-old, White, male identifies the benefit of regular involvement: Mother: . . . [Adolescent’s name]’s opening up to his PO a little more. He’s a very nice guy. He tries to have a more personal kind of relationship when they meet with him. And I think that helps [adolescent’s name]. As far as going into a lot of detail, you know, he’ll ask me how’s he doing. And he’ll tell me his grades need this, or you know, or because he’s in contact with the school obviously, and make sure he’s attending, and things. So it’s usually about 15 to 20 minutes. And now he’s on once, I think, every three weeks. He was going once every two weeks. The PO not only engages the parent in discussion about the adolescent, but she identifies the frequency with which the PO sees her son. The PO demonstrates care by taking the initiative to contact the school and report salient information back to the parent. Another parent describes a positive experience with her 15-year-old, Black, daughter’s PO who communicated regularly and provided advice:


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Interviewer: So on the juvenile court side of things, PO, you felt like they did a good job? Mother: Yeah and when I called them and talked to them they always gave me advice or if they needed me to—to have them come talk to her or whatever they come out here and do it. Plus the PO, they come out here every two days out of a week and makes sure she’s at home because she’s on home confinement. In the previous case, a number of factors led to this parent’s positive assessment: knowing that the PO would make contact twice a week, feeling supported by the PO, and the PO coming to the home versus having to go to the office.

Discussion The GP model (Stiffman et al., 2004) has been used to understand how recommendations from both formal and informal adult relationships influence youths’ pathway to mental health care. The GP model was used to better understand the juvenile PO’s role in court-involved youth’s pathway to mental health care. POs are faced with a difficult balancing act: to ensure public safety through enforcement of the law while accounting for rehabilitative needs of their clients; the juvenile PO is often expected to oversee some aspects of youth clients’ connection to care. Analysis of courtinvolved youths’ experiences illustrated PO-specific factors which improved or impaired connection to mental health care. Guardians and their youth described the role of their PO as pivotal to either facilitating or impairing the pathway to care. In the current study we sought to explore juvenile POs’ capacity to act as GPs to mental health care for justice-involved youth. Consistent with the GP model (Stiffman et al., 2004), a number of individual- and system-level factors specific to POs influenced the pathway to care. These factors are organized in the discussion according to their alignment with either the law enforcement orientation, focused on public safety, or the rehabilitative orientation, focused on client-oriented goals. Due to the GP model’s ability to explain juvenile POs’ capacity to connect youth clients to care, those POs who fit the GP model were found to be more aligned with rehabilitation. On the contrary, those POs who didn’t fit the GP model were found to be aligned with the law enforcement orientation. These competing orientations were both evident in our data and in line with the literature on juvenile PO roles (Blake, 1948; Clear & Latessa, 1993; Meeker, 1948; Ohlin et al., 1956; Rosecrance, 1986; Steiner et al., 2004); this led to an organizational structure allowing for examination of our results as they aligned with law enforcement or rehabilitation orientations. In the following discussion, we will examine how these factors influenced the stated goals of connection to care and progress toward completion of courtinvolvement in the context of working relationships with court-involved youth and their guardians.


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Individual Probation Officer Orientation Tension: Law Enforcement Versus Rehabilitation Punitive Versus “Genuinely Caring” Participants described a variety of PO attitudes, ranging from being punitive to “genuinely caring.” One parent described their caring PO as nonpunitive and distinguished her as “a stark difference” to POs who seem just like “prior police” who emphasize punishment. This distinction between a probation and police officer is substantial; when the family perceives a nonpunitive orientation they indicated increased motivation to work with the PO. One PO threatened programs and counseling services if the family got on the PO’s “bad side.” This threat served to frame mental health services as a punishment for the client while unnecessarily highlighting the power disparity in the PO–client relationship. Such an assertion disempowered the youth as an active decision maker. Further, the PO stressed the significant time commitment necessary to complete counseling services. Referral to services was wielded as a threat rather than appropriately framing the services as a means to address mental health concerns. Such framing misrepresents mental health as a negative rather than something that could be useful in her client’s rehabilitation. POs’ focus on punishment affected parents in the decision-making process. One mother perceived her son’s PO as seeking incarceration despite the family’s past commitment to access mental health care. The PO’s singular focus on criminal record and not on the family’s efforts to address mental health problems communicated an unwillingness to pursue rehabilitation. In another example of a punitive PO, a grandmother reported that despite her repeated attempts to communicate, the PO was unwilling to talk to her because the prosecutor forbade the PO from talking about the case with the family. Neither discussing the case nor pursuing mental health services led to the grandmother’s perception that the PO sought incarceration, perception which was compounded by the PO’s collaboration with the prosecution. Such alignment with the prosecution, rather than the family, exemplifies a punitive PO orientation as perceived by the family. This perception by parents seemed to create an adversarial relationship between the parent and PO rather than one of collaboration.

Exasperation/Stubbornness Versus Flexibility Participants also reported a great deal of variability in how their POs responded to adverse or unexpected events. One mother described her son’s PO as becoming exasperated when she called to reschedule an appointment. In response, the PO stated that changing the appointment would not be possible. After pleading and explaining the reasons as to why she could not make the initial appointment, the PO finally offered an appointment on a different day. Although the parent expressed gratitude for the appointment change, she reported dreading the new appointment due to the initial inflexibility. Another parent reported that her daughter’s PO didn’t want to “deal with


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[her daughter]” after a fight at school, regardless of the fact that significant progress had been made in counseling. These instances exemplify an approach more aligned with a law enforcement orientation because adverse or unexpected events were viewed as reason for punishment. However, such adverse events could serve as opportunities to learn from as well as to inform future rehabilitative efforts. future rehabilitative efforts. Rehabilitation could then be tailored to address salient issues which emerge in the course of probation with the goal of reducing the risk of recidivism. In an example of great flexibility, a mother reported that her son’s PO allowed her to pay court dues in-line with receipt of her monthly child-support check. The PO’s flexibility was recognized by this parent and facilitated movement toward the goal of eventually completing probation and concluding court involvement.

Lack of Follow-Through Versus Coordination A recent examination of juvenile POs’ approaches and strategies investigated variability in the different case management orientations, utilization of different compliance practices with clients, and frequency of contact with clients and with other service providers on their clients’ behalf (Schwalbe & Maschi, 2009). POs who made fewer contacts on their clients’ behalves possessed a more punitive case management orientation (Schwalbe & Maschi, 2009). Consistent with previous findings, punitive POs in the current study were unlikely to coordinate services or make referrals to appropriate care. A lack of referral to needed care is consequence of POs who deemphasize the importance of rehabilitation for juvenile offenders. This orientation stresses only those probation tactics associated with public safety while overlooking the potential role of the PO as a GP to care. In some cases, POs played an important role in identifying mental health services for clients. One parent reported that the PO offered to find a counselor for her daughter and was a great resource for the family. Another parent explained that her daughter’s PO believed that counseling would be a good idea and advocated for her client to get mental health services at a community mental health center. In yet another case, a mother reported that without getting a referral from the PO, she wouldn’t have been able to identify services and connect her child to care, citing the socioeconomic factor of not having a computer. She went on to explain that without a computer or someone in your social network who is knowledgeable or familiar with community resources, it can be extremely difficult to access services. In addition, parents underscored the importance of regular communication with their PO. Regular, continuous communication with clients was found to be more aligned with a rehabilitative orientation because it emphasizes client improvement over the protection of public safety in the face of adversity. Adverse events provided POs the opportunity not only to give advice and support when things weren’t going well but also to provide encouragement and reinforcement when things were going well. Unvarying communication conveyed a sense of caring to the family regardless of the absence or presence of adversity common to the rehabilitative process of courtinvolved youth with mental health concerns.


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Systemic Factors Variability in probation departments’ organizational structure may inhibit or impair POs’ ability to prioritize connection to mental health care (Glisson & James, 2002). For instance, a recurring theme was that of the PO only interacting with the family when something negative happened. Although POs whose interaction was contingent on an adverse event were common among our sample, one parent attributed the lack of interaction to their perception that the PO had “250 cases.” The exact caseload size is unclear, but the parent’s perception is that the lack of interaction was due a systemic factor: the PO having too high of a caseload, not a lack of personal effort. This notion was supported by a national survey of probation and parole officers: The actual probation and parole officer caseload mean was 106, whereas the desired, manageable caseload was found to be 77 (DeMichele, 2007, p. 44). Systemic factors such as high caseload could explain a number of the negative PO characteristics perceived by participants in this study, including a focus on punishment and a lack of flexibility in rescheduling. Conversely, a manageable caseload could allow POs more time to identify and access resources for their clients; identified by participants as a desired outcome. This is consistent with recent findings on the effectiveness of intensive supervision probation (ISP) programs with adult high-risk populations (Jalbert, Rhodes, Flygare, & Kane, 2010). Probationers with mental health concerns, one such at-risk population, are less likely to recidivate when they are supervised by POs with smaller caseloads who focus on rehabilitation rather than punishment, an approach which can significantly reduce recidivism rates (Jalbert et al., 2010). Recidivism reduction with high-risk adults suggests that smaller caseloads for high-risk juvenile populations could aid in reducing future court-involvement. The extant literature on smaller caseloads for high-risk adults combined with our findings suggest the need for further investigation on systemic interventions to improve outcomes for similar youth populations such as the participants in the current study. Organizational culture and climate within teams of child welfare and juvenile justice professionals were found to have a profound effect on connection to mental health care for their clients (Glisson & Green, 2006). Cultural factors within a probation department’s organizational structure could have a profound effect on how POs interact with their clients. Although POs may not always work on a team of service providers, the organizational culture within their department may influence their likelihood of referral to care. A supervisor who stresses knowledge of community resources and advocates for clients suspected of mental health problems to be referred to care will operate differently than one who instructs POs to always recommend incarceration if the conditions of probation are violated. In addition, if a probation department’s values system stresses isolated interaction with clients, PO–client working relationships may produce different outcomes than if regular interaction and collaboration with clients were emphasized. Such variability can have a profound effect on ability of POs to make decisions autonomously or based on the departments culture and climate. Although our data does not include information about institutional culture and super-


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visory mandates, parents in the current study reported great variability in PO orientation; its origin remains obscure due to this study’s exclusion of POs as participants.

Limitations The current study explores the views of youth and caregivers from a Midwestern U.S. state. The views of juvenile POs were not gathered, and we expect the study results would vary considerably if their perspective were included. However, it is particularly important to gather the viewpoint of youth and caregivers as they are vital participants in the juvenile court process (Garfinkel & Center, 2010). In addition, this is a qualitative study which included 19 youth and 20 caregivers, precluding the possibility of quantitative analysis of connection to mental health care due to the study’s exploratory nature. Through this study, it was apparent that caregivers and youth experienced the tension between law enforcement and rehabilitation functions of juvenile PO. The current study provides the groundwork for further investigation of which approaches may be more effective in connecting youth to care, and what tactics may be useful for those at higher risk, particularly those with mental health concerns. Hence, future research examining juvenile PO orientation and attitudes and their role in connection to mental health care for their clients is warranted. Lastly, we assessed a very specific population (detained youth with mental illness). Their views may reflect specific experiences of youth and caregivers that do not reflect the general population of youth involved in juvenile justice. In the current study, there was a 70% participation rate. There is no data on the 30% who didn’t make the scheduled appointment. As a result, one limitation of this study is the lack of data with which to compare those who were a part of the final sample with those who were not. As is common with qualitative research, we did not originally hypothesize that the role of the PO would be so important, rather the purpose of the study was simply to identify barriers and facilitators to mental health care for court-involved youth with mental health concerns. The importance of the PO emerged during analysis. As a result, we do not believe that nonparticipants had different beliefs than the final sample of participants in regards to attitudes toward POs.

Conclusions and Recommendations The relationship between juvenile POs and their clients has a substantial effect on both connection to mental health care and completion of court-ordered directives. This relationship is emphasized in the GP model and is subject to variability within a number of individual and systemic factors, consistent with the GP model (Stiffman et al., 2004). Our findings suggest that knowledge of community resources and the ability to advocate for clients’ receipt of services is crucial for court-involved youth with mental health needs. In addition, being flexible, taking initiative, and creative problem solving were all seen as conducive toward meeting the working-relationships-stated goals while being appraised positively light by clients and their families.


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An organizational structure which allows for a manageable caseload and emphasizes mental health care solutions is recommended because it allows for greater development of the youth–PO relationship, thereby increasing the likelihood that a youth in need of services will ultimately receive them. The origin of PO orientation is dependent on both personal and departmental factors; investigation of the etiology of PO orientation is warranted. Further research should investigate the complicated relationship between POs’ attitudes toward mental health, the organizational culture, climate, and value system of probation departments, and how the availability of mental health professionals in the community may affect POs’ decision to refer to care. Acknowledgment We would like to thank each of the site coordinators for their invaluable help in completing this study including Dan Arendas (Cook County), Lyda Abell (Clark County), Kristi Bruther (Johnson County), as well as Gael Deppert and Arthur Carter (Marion County).

Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding This study was funded by grants from the Indiana Criminal Justice Institute and grant R40 MC 08721, through the U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program.

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DeMichele, M. (2007). Probation and parole’s growing caseloads and workload allocation: Strategies for managerial decision making (O. O. J. Program, Trans.). Washington, DC: Bureau of Justice Assistance. Fazel, S., Doll, H., & Långström, N. (2008). Mental disorders among adolescents in juvenile detention and correctional facilities: A systematic review and metaregression analysis of 25 surveys. Journal of the American Academy of Child & Adolescent Psychiatry, 47, 1010-1019. Garfinkel, L., & Center, P. (2010). Improving family involvement for juvenile offenders with emotional/behavioral disorders and related disabilities. Behavioral Disorders, 36(1), 52-60. Glisson, C., & Green, P. (2006). The effects of organizational culture and climate on the access to mental health care in child welfare and juvenile justice systems. Administration and Policy in Mental Health and Mental Health Services Research, 33, 433-448. Glisson, C., & James, L. R. (2002). The cross-level effects of culture and climate in human service teams. Journal of Organizational Behavior, 23, 767-794. Grisso, T., Barnum, R., Fletcher, K., Cauffman, E., & Peuschold, D. (2001). Massachusetts youth screening instrument for mental health needs of juvenile justice youths. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 541-548. Guba, E. G. (1981). Criteria for assessing the trustworthiness of naturalistic inquiries. Educational Technology Research and Development, 29(2), 75-91. Hinton, W. J., Sims, P. L., Adams, M. A., & West, C. (2007). Juvenile justice: A system divided. Criminal Justice Policy Review, 18, 466-483. Jalbert, S., Rhodes, W., Flygare, C., & Kane, M. (2010). Testing probation outcomes in an evidence-based practice setting: Reduced caseload size and intensive supervision effectiveness. Journal of Offender Rehabilitation, 49, 233-253. Leifker, D., & Sample, L. L. (2010). Probation recommendations and sentences received: The association between the two and the factors that affect recommendations. Criminal Justice Policy Review. Advance online publication. doi:10.1177/0887403410388405 Mays, N., & Pope, C. (2000). Assessing quality in qualitative research. British Medical Journal, 320(7226), 50-52. Meeker, B. (1948). Probation is casework. Federal Probation, 12, 51. Ohlin, L., Piven, H., & Pappenfort, D. (1956). Major dilemmas of the social worker in probation and parole. National Probation and Parole Association Journal, 2(3), 15. Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed). Thousand Oaks, CA : SAGE Publications. QSR. (2008). NVivo 8. Rogers, K., Zima, B., Powell, E., & Pumariega, A. (2001). Who is referred to mental health services in the juvenile justice system? Journal of Child and Family Studies, 10, 485-494. Rosecrance, J. (1986). Probation supervision: Mission impossible. Federal Probation, 50, 25. Schwalbe, C., & Maschi, T. (2009). Investigating probation strategies with juvenile offenders: The influence of officers’ attitudes and youth characteristics. Law and human behavior, 33, 357-367. Snyder, H. N., & Sickmund, M. (2006). Juvenile offenders and victims: 2006 national report. Office of Juvenile Justice and Delinquency Prevention, 253. Retrieved from http://www. ojjdp.gov/ojstatbb/nr2006/


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Bios Evan D. Holloway is a research project coordinator in the Department of Pediatrics at the Indiana University School of Medicine. His research interests include adolescent sexuality and the mental health needs of youth involved in juvenile justice. James R. Brown is an Assistant Professor of Social Work at the University of WisconsinOshkosh. His research interests are parents experiences in reporting bullying, state’s anti-bullying laws, and juvenile delinquency. James has 13 years of practice experience as a school social worker. Philip D. Suman is an adjunct faculty member at the Indiana University School of Social Work and a practicing clinical social worker with juvenile justice populations. His research interests include mental health treatment and community collaboration for adolescents involved in juvenile justice systems. Matthew C. Aalsma is an associate professor in the Department of Pediatrics at the Indiana University School of Medicine. His research interests focus on adolescent health behavior including the physical and mental health needs of youth involved in juvenile justice.
