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Psychological Services Prevalence of Internalizing, Externalizing, and Psychotic Disorders Among Low-Risk Juvenile Offenders Tamara Kang, James M. Wood, Jennifer Eno Louden, and Elijah P. Ricks Online First Publication, March 13, 2017. http://dx.doi.org/10.1037/ser0000152

CITATION Kang, T., Wood, J. M., Eno Louden, J., & Ricks, E. P. (2017, March 13). Prevalence of Internalizing, Externalizing, and Psychotic Disorders Among Low-Risk Juvenile Offenders. Psychological Services. Advance online publication. http://dx.doi.org/10.1037/ser0000152

Psychological Services 2017, Vol. 14, No. 2, 000

© 2017 American Psychological Association 1541-1559/17/$12.00 http://dx.doi.org/10.1037/ser0000152

Prevalence of Internalizing, Externalizing, and Psychotic Disorders Among Low-Risk Juvenile Offenders Tamara Kang, James M. Wood, Jennifer Eno Louden, and Elijah P. Ricks

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The University of Texas at El Paso To effectively allocate mental health services, agencies must be able to predict what proportion of youth will have a mental disorder. Prevalence estimates are available for juvenile offenders at intake, detained youth, and incarcerated youth, but there is limited research on prevalence of mental disorders for juvenile offenders who are low-risk to reoffend, many of whom are first time offenders (i.e., low-risk youth). To complicate matters, ethnic minorities are disproportionately represented in the justice system, and specifically, little is known about culturally sensitive clinical interviewing. To aid service providers and administrators in allocating mental health resources for low-risk offenders and to contribute to knowledge on culturally sensitive clinical assessment techniques, the present study reports the prevalence of mental disorders for a mostly Mexican American sample of 503 low-risk youth in diversion programming. We found that approximately 1 of every 6 (17.1%) low-risk juvenile offenders had a current affective, anxiety, or psychotic disorder, and 24.9% of low-risk juvenile offenders met criteria for a current substance/alcohol abuse disorder. These results suggest that allocating a portion of specialty mental health services and substance abuse treatment for low-risk juvenile offenders may help agencies combat the issue of repeat offending by offering public health interventions proactively to indirectly prevent recidivism rather than reacting afterward. Lastly, recommendations are given to help service providers incorporate culturally sensitive techniques into clinical assessment in order to better identify Mexican American juvenile offenders with mental health needs. Keywords: prevalence, mental disorder, juvenile offenders, low-risk, diversion

2000; Redlich, Steadman, Monahan, Petrila, & Griffin, 2005; Skowyra & Cocozza, 2007; Watson, Hanrahan, Luchins, & Lurigio, 2001). Grisso and Underwood (2004) have identified the legal and public policy considerations that obligate juvenile justice agencies across all jurisdictions to evaluate and provide treatment for juvenile offenders with mental health problems.1 First, whenever children and adolescents are detained by the juvenile justice system, the juvenile justice agency automatically becomes their legal custodian and must ensure that they receive at least the same level of medical and mental health care that they would receive in the community. For example, some juvenile offenders with a mental illness in detention facilities are at elevated risk for suicide (Bushe, Taylor, & Haukka, 2010). Under the doctrine of parens patriae, juvenile justice agencies have a legal responsibility to be vigilant for such problems and provide appropriate interventions (Semier, 1979). Due process rights create a second set of legal responsibilities toward youthful offenders with mental health problems. Specifically, juvenile justice agencies in many states are obligated to provide appropriate interventions to ensure that youthful defendants with intellectual disabilities or psychological disorders fully understand the legal charges against them, comprehend their rights, and can knowledgably participate in any legal proceedings against them (Grisso & Underwood, 2004).

Policymakers have identified the mental health needs of children and adolescents as an underaddressed and urgent national problem in the United States (Centers for Disease Control & Prevention, 2013; Satcher, 2000). This issue is especially relevant to youth in the juvenile justice system, who are more likely to suffer from mental disorders compared to children and adolescents in the general population (Teplin, Abram, McClelland, Dulcan, & Mericle, 2002; Underwood & Washington, 2016; Wasserman, McReynolds, Lucas, Fisher, & Santos, 2002). In recent years, juvenile justice agencies have begun to adopt targeted programs, such as mental health courts and specialized case management approaches, to assist youthful offenders with psychological disorders (Almquist & Dodd, 2009; Arredondo et al., 2001; Burriss, Breland-Noble, Webster, & Soto, 2011; Cocozza & Skowyra,

Tamara Kang, James M. Wood, Jennifer Eno Louden, and Elijah P. Ricks, Department of Psychology, The University of Texas at El Paso. Elijah P. Ricks is now at Department of Psychology, Roosevelt University. We thank the members of the El Paso Juvenile Probation Department, especially Roger Martinez, Marc Marquez, Linda Garcia, and Salvador Leos, for their contributions to planning and sponsoring the project. We also thank Rachell L. Jones, Joseph Charter, Chelsea Spraberry, and Megan O’Connor for conducting diagnostic interviews, as well as Paloma Moreno and Viviana Valenzuela for assisting with data entry. Correspondence concerning this article should be addressed to Tamara Kang, Department of Psychology, The University of Texas at El Paso, TX 79968. E-mail: [email protected]

1 Each jurisdiction has immense discretion on the extent to which the agency provides evaluation and treatment for mental health problems.

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A third set of legal obligations arises from the statutory responsibility of juvenile justice agencies (e.g., Juvenile Justice and Delinquency Prevention Act of 2002) to protect the public and reduce illegal activity by juvenile offenders. To fulfill this goal, agencies may need to provide mental health services to some youthful offenders in order to promote their rehabilitation and reduce their subsequent involvement in crime (Andrews, Bonta, & Wormith, 2006; Bonta & Andrews, 2007).

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Defining the Scope of the Problem As the mental health problems of delinquent youth have received increasing attention during the past few decades, the need has grown for accurate estimates concerning the prevalence of psychological problems in this population. For example, policymakers and administrators who allocate funds for psychological evaluations and mental health treatments in the juvenile justice system can plan more effectively if they know, at least approximately, the percentage of youth who are likely to require such services. Estimates of prevalence of mental disorders are currently available for a wide variety of juvenile offenders with different levels of justice involvement including juvenile offenders from intake (Wasserman, McReynolds, Ko, Katz, & Carpenter, 2005), detained youth (Dixon, Howie, & Starling, 2004; Duclos et al., 1998; McCabe, Lansing, Garland, & Hough, 2002; Schubert, Mulvey, & Glasheen, 2011; Teplin et al., 2002), and incarcerated youth (Atkins et al., 1999; Wasserman et al., 2002, 2004). These subpopulations of juvenile offenders at different levels of justice involvement are repeat offenders, or offenders that have committed more severe offenses. A subpopulation of juvenile offenders that is highly understudied are youth that are low-risk to reoffend with less severe offenses (e.g., drug possession, assault for fighting at school), many of whom are first-time offenders (i.e., low-risk juvenile offenders). With the empirically supported relationship between mental health and criminal behavior (i.e., untreated mental disorders can prevent youth from responding to interventions for criminal behavior [Andrews & Bonta, 2010], or can increase the adolescent’s exposure to risk factors for crime, which in turn increases the adolescent’s propensity for future criminal behavior [Skeem, Manchak, & Peterson, 2011]) low-risk juvenile offenders may offer a unique opportunity for early intervention to prevent low-risk offenders from returning to the juvenile justice system.

Ethnic Differences in Prevalence of Psychological Disorders Ethnic minorities are overrepresented in the juvenile justice system (U.S. Department of Justice, 1999). Latinos are the second fastest growing population with an increase of 1.1 million Latinos reported in the 2012 Census (U.S. Census Bureau, 2014). Approximate numbers of Latinos involved in the juvenile justice system have inconsistencies across studies and the differing definitions of “Latino” make determining Latinos’ involvement in the juvenile justice system hard to determine. Many times Latino juvenile offenders are classified as Caucasian when statistics are reported (U.S. Department of Justice, 1999). Due to the overrepresentation of ethnic minorities in the juvenile justice system (U.S. Department of Justice, 1999), and the growing awareness of mental health problems in justice settings, there is

reason to investigate whether prevalence of psychological disorders varies across different ethnic groups. Specifically, there is evidence that the prevalence of psychological disorders may vary among different ethnic groups in the United States, though few studies have explicitly examined this issue among individuals involved in the justice system (e.g., U.S. Department of Justice, 1999). In community samples, studies have found the prevalence of specific disorders to differ by ethnicity, with Latinos less likely to be diagnosed with anxiety disorders (Asnaani, Richey, Dimaite, Hinton, & Hofmann, 2010), but more likely to report comorbid depressive disorders (Blazer, Kessler, McGonagle, & Swartz, 1994) and symptoms of dysthymia (Riolo, Nguyen, Greden, & King, 2005) compared with non-Latino European Americans. In a study of detained juveniles, Teplin and her colleagues (2002) found that Latino youths were less likely to have a substance use or behavioral disorder, but more likely to have an anxiety disorder, compared with non-Latino European American youths. However, Johnston, O’Malley, Bachman, and Schulenberg (2010) found rates of substance use and exposure to substances in high school to be higher among Latino youth compared with European American and African American youth. Such findings suggest that factors related to ethnicity may affect the prevalence of psychological disorders among Latino juvenile offenders. Possible explanations may relate to immigration status of Latino individuals (Alegría et al., 2008), differential expression of mental illness symptoms (Cuellar & Paniagua, 2000; Ruiz, 1985), culturally based views of mental illness and its treatment (Alvidrez, 1999; Kleinman, 1988; Gonzalez, 1997; Vega & Alegría, 2001), cultural stigma attached to mental illness (Alvidrez, 1999), and interpretations of mental health symptoms as spiritual concerns, rather than medical or psychological issues (Ruiz, 1985).

The Present Study Given the current state of the literature, there is a gap in determining the prevalence of psychological disorders for juvenile offenders who are low-risk to reoffend and diverted into diversion programs, many of whom are first-time offenders. Furthermore, with minorities being overrepresented in the juvenile justice system (U.S. Department of Justice, 1999) and Latinos being the second fastest growing population (U.S. Census Bureau, 2014), there is a need to estimate prevalence rates for a majority Latino sample of low-risk offenders. The present study contributes to the literature in two specific ways. First, the present study focuses on estimating the prevalence of psychological disorders for low-risk juvenile offenders who have been channeled into diversion programs (described subsequently), including many first-time offenders. The prevalence of psychological disorders in this particular subpopulation of juvenile offenders has received little attention in the past. This will aid juvenile probation agencies in planning and allocating mental health resources for juvenile offenders in diversion programs. Second, the present study estimates the prevalence of mental disorders for a predominantly Mexican and Mexican American Latino population of low-risk juvenile offenders.

PREVALENCE OF DISORDERS

Method

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Participants Participants were 503 juvenile offenders from a juvenile probation agency in a medium-sized city (i.e., population approximately 650,000) in the southwestern United States. All had been classified as low-risk to reoffend by the juvenile probation department using a risk assessment instrument. In accordance with their low-risk status, they continued to live in the community (usually with their family) and were assigned to either (a) a standard deferred prosecution program (i.e., DP-180), in which the juvenile offender was monitored for 3 to 6 months by a supervising probation officer, or (b) a community court program, in which a panel of volunteers heard the juvenile offender’s case and then assigned him or her to perform community service as restitution (i.e., Juvenile Court Conference Committee [JCCC]).

Procedure For the purposes of the research study, the agency allowed doctoral students from the research team to administer the K-SADS diagnostic interview (described subsequently) to all lowrisk juvenile offenders assigned to the DP-180 diversion program between May 2011 and December 2012. The agency partnered with the research team so that the doctoral students could evaluate the eligibility of the juvenile offenders in the DP-180 diversion program for assignment to a new mental health court the agency created. The research team attempted to conduct a K-SADS diagnostic interview with all juvenile offenders assigned to the DP-180 diversion program during the study period (N ⫽ 456). However, approximately 23.1% (n ⫽ 105) of them were not referred, usually because of scheduling difficulties or administrative errors. The 351 low-risk juvenile offenders assigned to the DP-180 diversion program appear to be a typical cross-section of all low-risk juvenile offenders assigned to DP-180 diversion program as there were no significant differences between juvenile offenders in the DP-180 diversion program who were interviewed compared to juvenile offenders who were unable to be interviewed with respect to gender, ␹2(1, N ⫽ 456) ⫽ 0.93, p ⫽ .334, ␾ ⫽ 0.04, ethnicity, ␹2(5, N ⫽ 456) ⫽ 4.70, p ⫽ .454, ␾ ⫽ 0.10, or age, t(453) ⫽ 0.06, p ⫽ .950, d ⫽ 0.01. Further, the attrition rate for the present study (i.e., 23.1% of juvenile offenders assigned to the DP-180 diversion program who were not able to be interviewed) is comparable to the attrition rate for other studies that estimated prevalence of mental disorders among juvenile offender populations (Duclos et al., 1998; Schubert et al., 2011; Wasserman et al., 2004, 2005). In addition to the 351 low-risk juvenile offenders assigned to the DP-180 diversion program, intake officers referred 152 juvenile offenders assigned to a community court diversion program (i.e., JCCC) for diagnostic interviews even though they were not part of the intended sample (i.e., juvenile offenders assigned to DP-180 diversion program). Therefore, the final study sample (N ⫽ 503) consists of low-risk juvenile offenders assigned to the DP-180 diversion program (n ⫽ 351), and low-risk juvenile offenders assigned to the JCCC diversion program (n ⫽ 152), all of whom are low-risk to reoffend, and many of whom are first-time offenders. Each interview lasted between 30 and 90 min, depending on the number of mental health problems reported by the juvenile of-

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fender. The interviewers were six graduate students enrolled in a master’s-level clinical psychology program or in a doctoral-level program in legal psychology, including one doctoral student who already had a master’s degree in clinical psychology and a year of postdegree clinical experience. All interviewers completed formal graduate-level courses in psychopathology and diagnostic interviewing either before the study began or while it was underway. In addition, prior to the commencement of data gathering, all interviewers attended a 2-day workshop conducted by two doctoral level psychologists with experience and expertise in clinical diagnosis and structured interviewing. This workshop included (a) an overview of the history and research base of structured clinical interviewing, (b) detailed lectures on the K-SADS structure and administration procedures, and (c) role plays observed by the instructors in which each trainee conducted two or three K-SADS interviews and served as a simulated patient in an additional two or three interviews. After the instructors determined that the trainees were able to administer the K-SADS with close adherence to its procedures, the trainees began to interview juveniles. A master’s-level experienced clinical psychologist observed some of these initial interviews (usually at least three), offering feedback and direction and ensuring that the interviewers adhered to K-SADS procedures. Subsequently, the results of the diagnostic interviewers were reported to a doctoral level licensed clinical psychologist who reviewed diagnostic decisions. Three additional procedures were followed to ensure reliability and validity of diagnostic decisions. First, interviewers discussed nearly all interviews at weekly group supervision meetings and received feedback from fellow interviewers and from two supervisors with doctoral degrees and expertise in diagnosis (the second and third authors). Second, secondary raters independently listened to and rated recordings of clinical interviews for the presence or absence of symptoms (discussed in more detail subsequently). Third, a doctoral level supervisor listened to these same recorded interviews to ensure that K-SADS administration procedures were being followed and assess the reliability. Interviewers took turns recording the interviews that were evaluated by each other and by the doctoral level supervisor. Interviewers approached a juvenile and his or her parents prior to an interview and asked permission to record it. Although these interviews were not randomly selected, the interviewers had no prior knowledge of the juveniles or their symptoms. If the juvenile and parent agreed, the recorded interviews were then made available via a digital audio recorder and/or a secure external hard drive for the other trained interviewers to review. The other available interviewers were secondary raters and completed the K-SADS questionnaire sheets while listening to the recording, rating each of 176 symptoms on a 0 to 3 scale. Over the course of the project, six interviewers recorded a total 14 interviews. Each recorded interview was reviewed by as many raters as possible for comparison to the original interviewer’s ratings. Some raters had graduated and were no longer available to rate later interviews, thus each recorded interview was rated by at least one additional interviewer, and some were rated by as many as five of the other interviewers. The mean number of additional interviewers for each recording was 3.6 (median was 4). This process resulted in 50 comparisons between an original interviewer and the secondary raters. A weighted kappa statistic was computed for each comparison to

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assess agreement. The mean weighted kappa for all 50 comparisons was .82 (SD ⫽ .14). A kappa of .70 is conventionally considered adequate interrater reliability (Banerjee, Capozzoli, McSweeney, & Sinha, 1999). Thus, the level of agreement among raters in the present study suggests a generally good level of agreement regarding the presence or absence of symptoms. Of all 50 comparisons, only seven resulted in kappa values of less than .70, and these could often be attributed to newer raters’ lack of familiarity with the K-SADS. In addition to comparing the symptom scores, raters also made final diagnoses based on the overall information from the recording. The diagnoses gleaned from recorded interviews could not be compared using interrater reliability statistics, but were instead discussed by the diagnosticians and supervisors in weekly research meetings. Notes from the interviews were compared, and a general consensus on diagnoses was reached. This method was not unlike the common practice of reviewing the interview with a supervisor to agree upon the final diagnosis. There were no instances in which major changes were made in a juvenile offender’s diagnosis (e.g., anxiety disorder reclassified as a mood disorder) on the basis of discussion during these meetings.

Measures K-SADS. Each juvenile offender was interviewed individually using the K-SADS (Axelson, Birmaher, Zelazny, Kaufman, & Gill, 2009; Kaufman, Birmaher, Brent, Rao, & Ryan, 1996): a semistructured diagnostic interview intended to assess current (anytime during last 2 months) and past psychological disorders in children and adolescents according to the criteria of the DSM (4th ed.; American Psychiatric Association, 2000). The first part of the K-SADS consists of a screening interview in which the juvenile offender is asked about symptoms of a wide variety of Axis I psychological disorders or syndromes, including affective disorders (major depression, dysthymia, hypomania, mania, or cyclothymia), psychotic disorders (schizophrenia or schizophrenia-spectrum disorders), anxiety disorders (panic disorder, agoraphobia, separation anxiety disorder, posttraumatic stress disorder, social phobia, simple phobia, generalized anxiety disorder, and obsessive-compulsive disorder), disruptive behavior disorders (conduct disorder, oppositional defiant disorder), and substance abuse disorders (including alcohol abuse and alcohol dependence). Each symptom is measured on a 0 to 3 scale (0 ⫽ no information to determine the presence or absence of a symptom, 1 ⫽ symptom was not present, 2 ⫽ symptom was present but did not meet full criteria, 3 ⫽ symptom met full criteria). If the juvenile offender’s responses during the screening interview suggest the presence of a psychological disorder, either currently or in the past, the interviewer follows up by administering supplemental interview sections of the K-SADS to gather more information about the juvenile offender’s mental health symptoms. The supplemental interviews include modules for psychotic disorders, affective disorders, anxiety disorders, disruptive behavior disorders, and substance use disorders. On the basis of the juvenile offender’s responses in the screening and supplemental interviews, the interviewer assigns psychological diagnoses to the juvenile offender according to DSM criteria and scoring algorithms included in the K-SADS.2

Juvenile probation department case files. Demographic data (e.g., age, ethnicity) and referral records were obtained directly from the juvenile probation department’s internal recordkeeping system. The system includes both electronic and paper records and is used by juvenile probation officers and administrators to monitor individual juvenile offenders and guide the administration of services.

Results To address the aims of the present study, first, the prevalence of DSM Axis I psychological disorders and suicidality was calculated for the low-risk juvenile offenders in the present sample. Second, these prevalence figures were broken down by gender because prior research suggests that prevalence of some categories of psychological disorders (e.g., affective disorders) are significantly different for females compared to males (Kring, Johnson, Davison, & Neale, 2013; Van Damme, Colins, & Vanderplasschen, 2014). The majority of the 503 juvenile offenders were male (66.8%). Consistent with the demographics of their community in the Southwestern United States (U.S. Census Bureau, 2014), most were Latino (83.3%), with small numbers of non-Latino European Americans (12.5%), African Americans (3%), and other ethnic groups (1.2%). Latinos are a heterogeneous ethnic group, so to specify, the present study included primarily Mexicans and Mexican Americans. Ages ranged from 10 to 17 years (M ⫽ 14.8, SD ⫽ 1.5).

Prevalence Estimates for Low-Risk Juvenile Offenders Table 1 shows current and lifetime prevalence rates of affective disorders, anxiety disorders, psychotic disorders, disruptive behavior disorders, and substance use disorders for the low-risk juvenile offenders in the present study. The most common diagnostic categories in the sample were substance use disorders (current diagnosis ⫽ 24.9%, lifetime diagnosis ⫽ 27.8%) and disruptive disorders (current ⫽ 15.7%, lifetime ⫽ 17.1%), followed by affective disorders (current ⫽ 9.0%, lifetime ⫽ 13.1%), anxiety disorders (current ⫽ 7.8%, lifetime ⫽ 8.6%), and psychotic disorders (current ⫽ 1.8%, lifetime ⫽ 2.0%). These diagnostic categories were then aggregated into three larger groups: internalizing/psychotic, externalizing and any disorder. First, the internalizing/psychotic group included any juvenile offender in the sample who had an affective, anxiety, or 2 Some diagnostic interviews had to be terminated by the interviewers due to time constraints. Interview supplements should have been administered but were missing for (a) disruptive disorders in 3.2% of the 503 interviews, (b) substance use disorders in 4.6% of interviews, (c) affective disorders in 1.6% of interviews, (d) anxiety disorders in 2.6% of interviews, and (e) psychotic disorders in 1% of interviews. These data can be used to compute “upper limits” on the prevalence estimates in Table 1. To illustrate, Table 1 reports that the prevalence of current disruptive behavior disorders in the present sample of 503 juvenile offenders was 15.7%. However, the K-SADS behavioral interview supplement should have been administered but was missing for an additional 3.2% of interviews. If it is assumed that all juvenile offenders with missing supplements would have been diagnosed with disruptive disorders if they had been administered the behavioral supplement, then the true prevalence of disruptive disorders in the sample could be as high as 18.9% (15.7% ⫹ 3.2%). Thus, the figure of 18.9% would be the upper limit for this prevalence estimate.

PREVALENCE OF DISORDERS

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Table 1 Prevalence Rates by Gender for the Present Study Females (n ⫽ 167)

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Type of psychological disorder Affective disorder: Any Major depression Dysthymic disorder Bipolar disorder Anxiety disorder: Any Generalized anxiety disorder Simple phobia Social phobia Posttraumatic stress disorder Separation anxiety disorder Panic disorder Obsessive-compulsive disorder Psychotic disorder: Any Disruptive disorder: Any Conduct disorder Oppositional defiant disorder Attention-deficit/hyperactivity disorder Substance/alcohol abuse or dependence Any disruptive or substance abuse disorder Any affective, anxiety, or psychotic disorder Any Axis I disorder

Males (n ⫽ 336)

Both (n ⫽ 503)

Current

Lifetime

Current

Lifetime

Current

Lifetime

13.8%ⴱⴱ 8.4%ⴱⴱ 1.2% 1.2% 10.2% 4.8%ⴱ 2.4% 1.2% 2.4% .0% 1.2% .0% 1.2% 12.6% 2.4% 4.8% 6.6% 18.6%ⴱ 25.7%ⴱⴱ 21.6% 37.7%

20.3%ⴱⴱ 14.4%ⴱⴱ 1.2% 3.0% 11.4% 4.8%ⴱ 2.4% 1.8% 3.0% .0% 1.2% .0% 1.8% 13.2% 2.4% 4.8% 7.2% 23.4% 29.3%ⴱ 30.5%ⴱⴱ 45.5%

6.6%ⴱⴱ 2.1%ⴱⴱ 2.1% .9% 6.6% 1.5%ⴱ .9% .9% 1.2% .3% .6% .3% 2.1% 17.3% 6.0% 3.3% 10.4% 28.0%ⴱ 38.4%ⴱⴱ 14.9% 45.0%

9.5%ⴱⴱ 3.9%ⴱⴱ 2.1% 1.5% 7.1% 1.5%ⴱ .9% .9% 1.8% .3% .6% .6% 2.1% 19.1% 6.3% 3.6% 12.5% 30.6% 40.8%ⴱ 19.3%ⴱⴱ 49.1%

9.0% 4.2% 1.8% 1.0% 7.8% 2.6% 1.0% .9% 1.6% .2% .8% .2% 1.8% 15.7% 4.8% 3.8% 9.2% 24.9% 34.2% 17.1% 42.5%

13.1% 7.4% 1.8% 2.0% 8.6% 2.6% 1.2% 1.1% 2.2% .2% .8% .4% 2.0% 17.1% 5.0% 4.0% 10.7% 27.8% 37.0% 23.1% 47.9%

Note. Chi-square analyses were conducted to determine if the prevalence rates for males were significantly different from the prevalence rates for females. The asterisk notation refers to statistical significance when comparing prevalence rates for males compared to females. ⴱ p ⬍ .05. ⴱⴱ p ⬍ .01.

psychotic diagnosis (Regier, Kuhl, & Kupfer, 2013). In the present sample, 17.1% of juvenile offenders had met criteria for the internalizing/psychotic group within 2 months of the interview and 23.1% had met criteria at some point during their lifetime. Second, the externalizing group included any juvenile who had a substance abuse, alcohol abuse, or disruptive behavior disorder. In the present sample, 34.2% of juvenile offenders had met criteria for this group within 2 months of the interview, and 37% had met criteria at some point during their lifetime. Third, the any disorder group included any juvenile who met criteria for the internalizing/ psychotic group, the externalizing group, or both. In the present sample, 42.5% of juveniles had met criteria for the any disorder group within 2 months of the interview, and 47.9% had met criteria at some point during their lifetime. The presence of suicidality was also evaluated. Overall, 3.8% of the juvenile offenders in the present sample reported at least one prior suicide attempt. As expected, suicidal ideation was more common than were suicide attempts. In the present sample, 4.4% of juvenile offenders reported experiencing recurrent suicidal ideation in the 2 months prior to the interview, and 9.1% reported recurrent suicidal ideation at least once in their lifetime. Gender differences. Table 1 also presents prevalence rates for psychological disorders separately by gender and the results of chi-square analyses that yielded significant differences in prevalence rates between genders. Consistent with well-established gender differences in psychopathology (see Kring et al., 2013), the prevalence of internalizing/psychotic disorders and externalizing disorders was substantially different among girls than among boys. Girls were more likely than boys to have an internalizing/psychotic disorder currently (21.6% vs. 14.9%), ␹2(1, N ⫽ 503) ⫽ 3.50, p ⫽ .061, ⌽ ⫽ 0.08, 95% CI [.00, .14], or during their lifetime (30.5%

vs. 19.3%), ␹2(1, N ⫽ 503) ⫽ 7.87, p ⫽ .005, ⌽ ⫽ 0.12, 95% CI [.03, .19]. Specifically, the current prevalence of affective disorders for girls (13.8%) was approximately double its prevalence for boys (6.6%), ␹2(1, N ⫽ 503) ⫽ 7.14, p ⫽ .008, ⌽ ⫽ 0.11, 95% CI [.02, .13], and similarly, the lifetime prevalence for affective disorders for girls (20.3%) was approximately double the lifetime prevalence for boys (9.5%), ␹2(1, N ⫽ 503) ⫽ 11.48, p ⫽ .001, ⌽ ⫽ 0.15, 95% CI [.04, .17]. Current prevalence rates of major depression were approximately 4 times as high for girls (8.4%) as for boys (2.1%), ␹2(1, N ⫽ 503) ⫽ 11.06, p ⫽ .001, ⌽ ⫽ 0.14, 95% CI [.02, .11]. Similarly, the lifetime prevalence for major depression for girls (14.4%) was more than 3 times the lifetime prevalence for boys (3.9%), ␹2(1, N ⫽ 503) ⫽ 18.05, p ⬍ .001, ⌽ ⫽ 0.18, 95% CI [.05, .16]. Conversely, males were significantly more likely than girls to have an externalizing disorder, either currently (38.4% vs. 25.7%), ␹2(1, N ⫽ 503) ⫽ 7.92, p ⫽ .005, ⌽ ⫽ 0.12, 95% CI [.04, .21], or during their lifetime (40.8% vs. 29.3%), ␹2(1, N ⫽ 503) ⫽ 6.25, p ⫽ .012, ⌽ ⫽ 0.11, 95% CI [.03, .20]. Boys also had higher rates of substance use disorders, including alcohol use disorders. For example, the current prevalence of substance or alcohol abuse or dependence was about 1.5 times as high among boys (28%) as among girls (18.6%), ␹2(1, N ⫽ 503) ⫽ 5.29, p ⫽ .021, ⌽ ⫽ 0.10, 95% CI [.02, .17]. Lifetime prevalence of substance or alcohol abuse or dependence was approximately 1.3 times higher among boys (30.6%) than among girls (23.4%), though this difference was not statistically significant, ␹2(1, N ⫽ 503) ⫽ 2.49, p ⫽ .114, ⌽ ⫽ 0.07, 95% CI [⫺.01, .15]. As can be seen in Table 1, no significant gender differences were found for psychotic disorders or for most other diagnoses except those already discussed. Finally, neither gender was signif-

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icantly more likely than the other to have at least one disorder (i.e., any disorder) either currently (37.7% for girls vs. 45.0% for boys) or during their lifetime (45.5% vs. 49.1%).

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Discussion The present study was a first step in estimating the prevalence of DSM Axis I mental disorders for a mostly Latino group of low-risk juvenile offenders, which will aid service providers in allocating specialty mental health resources, substance abuse treatment, and conducting gender-responsive interventions, and culturally sensitive clinical assessments for low-risk juvenile offenders. Although considered a low-risk group to reoffend, the results revealed that many low-risk juvenile offenders are in need of mental health services and substance abuse treatment. Second, consistent with gender responsive programming (Wright, Salisbury, & Van Voorhis, 2007), it appears that even with low-risk offenders, girls are in need of more mental health services for affective disorders compared with boys. Third, given that the sample was mostly Mexican American, the low rates found for anxiety disorders in the present study may suggest that for accurate reporting of mental health symptomology, culturally sensitive techniques may need to be utilized when conducting clinical assessments with Latino juvenile offenders.

Preventing Recidivism on the Front End: Being Proactive Rather Than Reactive Although research supports that intensive interventions for criminal behavior often make low-risk offenders reoffend (Andrews & Bonta, 2010), the same may not be true for public health interventions for mental disorders. Research suggests that mental health problems are indirectly related to increased recidivism rates among juvenile offenders (Becker, Kerig, Lim, & Ezechukwu, 2012; Wierson & Forehand, 1995) and pose obstacles to rehabilitation for criminality if not effectively treated (Andrews et al., 2006; Bonta & Andrews, 2007). Specifically, the presence of an untreated mental disorder will affect the risk factors of crime an offender endorses, and those risk factors in turn cause crime (Skeem et al., 2011). For example, major depression and dysphoric states increase the likelihood that an adolescent will abuse substances, and abusing substances is a robust predictor of future delinquency (Andrews & Bonta, 2010; Bonta & Andrews, 2007; Schubert et al., 2011). When an adolescent first enters the juvenile justice system, agencies conduct risk assessments to determine whether the adolescent is likely to be a repeat offender. Approximately 1 of every 6 (17.1%) low-risk juvenile offenders in diversion programs in the present study had a current affective, anxiety, or psychotic disorder. Given the indirect relationship between mental disorders and criminal behavior, low-risk juvenile offenders may offer a point of early intervention through frontend mental health interventions when youth first enter the juvenile justice system, which may indirectly prevent adolescents from committing future delinquent acts. Notably, even though the juvenile offenders in the present study are low-risk to reoffend and do not require intensive interventions to address criminality, they are experiencing concerning mental health issues and suicidal ideations and may benefit from specialty services including mental health courts and specialized

probation caseloads, which have demonstrated efficacy at preventing future recidivism. Substance abuse. As noted earlier, substance abuse is a robust predictor of recidivism (Andrews & Bonta, 2010; Bonta & Andrews, 2007; Schubert et al., 2011), and even though the juvenile offenders in the present study were at low risk to reoffend, they presented concerning substance abuse disorders that may increase their likelihood of future delinquency if left untreated. Out of the juvenile offenders in the present study, 18.6% of females and 28% of males had a substance/alcohol abuse or dependence. From other prevalence studies (Atkins et al., 1999; Dixon et al., 2004; Duclos et al., 1998; Schubert et al., 2011; Teplin et al., 2002; Wasserman et al., 2002, 2004), it appears that repeat juvenile offenders at different levels in the system (i.e., detained and incarcerated) also differ in levels of substance abuse and dependence, which suggests that low-risk offenders offer an early substance abuse intervention point for service providers, which may prevent the adolescent from returning to the juvenile justice system.

Gender Responsive Treatment Although low risk to reoffend, female juvenile offenders from the present study showed higher rates of any current affective, anxiety, or psychotic disorder (21.6%) compared with males (14.9%). Specifically, consistent with gender responsive treatment (Wright et al., 2007), low-risk female juvenile offenders had significantly higher rates of affective disorders (i.e., depressive and bipolar disorders; females ⫽ 13.8%) compared with males (6.6%). Therefore, service providers and administrators may benefit from allocating specialty mental health services (e.g., mental health courts) for low-risk female juvenile offenders even though they are low-risk to reoffend. There is an indirect relationship between internalizing problems and substance abuse evidenced by the high levels of co-occurring major depression and substance abuse found in prior research (Abram, Teplin, McClelland, & Dulcan, 2003). Therefore, because substance abuse is a robust predictor of future delinquency, allocating specialty mental health services for lowrisk female offenders with affective disorders may help improve quality of life and reduce their chance of future delinquency.

Culturally Sensitive Assessments The low-risk juvenile offenders in the present study appear to have substantially lower rates of anxiety disorders when compared to other studies that estimate prevalence of anxiety disorders for juvenile offenders at intake, detained youth, and incarcerated youth. For example, 7.8% of low-risk juvenile offenders from the present study met criteria for a current anxiety disorder whereas other studies found more than double that rate with current rates of anxiety disorders to be 19.8% (Wasserman et al., 2005), 33% (Schubert et al., 2011), 23.6% (Teplin et al., 2002), 33.3% (Atkins et al., 1999), 21.2% (Wasserman et al., 2004), and 19.5% (Wasserman et al., 2002). As discussed earlier, in community samples, studies have found Latinos less likely to be diagnosed with anxiety disorders (Asnaani et al., 2010), but more likely to report comorbid depressive disorders (Blazer et al., 1994) and symptoms of dysthymia (Riolo et al., 2005) compared with non-Latino European Americans. Similarly, Eno Louden, Kang, Ricks, and Marquez (in

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PREVALENCE OF DISORDERS

press) investigated the utility of a commonly used mental health screening tool, the Massachusetts Youth Screening InventorySecond Version (MAYSI-2; Grisso & Barnum, 2006) for Latino juvenile offenders and found that the Somatic Complaints subscale had a higher sensitivity to affective and anxiety disorders when compared with the Depressed-Anxious subscale. Eno Louden and colleagues (in press) concluded that Latinos are more likely to report physical symptoms rather than recognizing their own underlying mood disturbance. The present study’s findings for anxiety disorders suggest it may be useful for service providers to integrate culturally sensitive approaches into clinical diagnostic assessments, which may help ethnic minorities respond more truthfully during the assessment process, and lead to more accurate identification of ethnic minorities with serious mental disorders (i.e., affective, psychotic, and anxiety disorders; Regier et al., 2013). Prior research is in agreement with the present study’s findings and shows that Mexican American families are often highly uneducated about mental disorders and often, even after having substantial contact with mental health agencies, attribute mental disorder to familial issues (family arguments), alcohol or drugs, menstrual problems, maturating, and death of a family member among other reasons unrelated to mental health (Urdaneta, Saldaña, & Winkler, 1995). In one study, Mexican American caregivers were fully unaware of their child’s mental health problems and did not consider that the problems their child was having could be due to a mental disorder. Instead they thought their child was trying to seek attention or attempting to not take responsibility for their actions (Urdaneta et al., 1995). These types of beliefs about mental illness can affect how adolescents report mental health symptoms. For example, it may be more socially accepted in their culture to report physical symptoms rather than report a mood disturbance (Eno Louden et al., in press). Further, in Urdaneta and colleagues’ (1995) examination of Hispanic perceptions of mental illness, not one family sought out services from mental health providers to treat their child’s mental health issues. This type of resistance to mental health services may lead a child to underreport their symptoms so that they do not get referred to mental health treatment or lead to misidentification if the child reports physical aspects of the disorder rather than mood disturbances. Because cultural beliefs about mental disorders can affect an adolescent’s ability to accurately report mental health symptomology, it may be helpful for service providers to incorporate specific culturally sensitive techniques when assessing Mexican American juvenile offenders. For example, research suggests that Mexican American young adults are more resistant to using counseling services compared to European Americans, but if they did go to counseling they preferred counselors of the same ethnicity (Cauce et al., 2002). Out of six interviewers who administered the K-SADS in the present study, four were European American, one was Middle Eastern, and one was Asian. The lack of Latino interviewers may have led to hesitation in divulging some symptoms, which may partially explain the low prevalence rate of anxiety disorders found in the present study. Furthermore, many of the juvenile offenders in the present study were bilingual, with English as their second language, and they may have felt more comfortable expressing themselves about the mental health symptomology they were experiencing in Spanish rather than English. Consequently, for ethnic minorities with English as a second

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language, it may benefit agencies to allow juvenile offenders the option to speak with a treatment provider who is fluent in Spanish, or who is of the same ethnicity as the adolescent, whenever possible.

Limitations There are two notable limitations of the present study, which should be borne in mind when interpreting the results. First, for interrater reliability interviewers were allowed discretion on which parents to ask to audio-record a reliability interview. Although a random number generator was not used to select which parent(s) to ask, the interviewers did not have any previous knowledge about the juvenile offender before asking the parent(s) if the interviewer could audio record the interview with their child for reliability purposes. Second, the research team did not keep a log of when a parent and child would not allow the interviewer to record the clinical diagnostic interview. Majority of parents agreed to allow the interviewer to record the clinical interview with their child, but an exact number of declined invitations is not available.

Policy and Practice The present study’s findings offer two overarching recommendations for service providers, clinicians, and administrators at juvenile justice agencies. First, even though mental health resources are limited at agencies, allocating a portion of specialty mental health services (especially for females with affective disorders) and substance abuse treatment for low-risk offenders may help agencies combat the issue of repeat offending by offering public health interventions proactively to indirectly prevent recidivism rather than acting reactively. This tactic will allow agencies to intervene with mental disorders when the low-risk juvenile offender first comes into contact with the system rather than waiting until a juvenile offender’s untreated mental disorder exposes the adolescent to more risk factors for crime (Skeem et al., 2011), and leads to the adolescent becoming a repeat or serious offender and becoming embedded deeper in the juvenile justice system. Second, with the disproportionate number of ethnic minorities involved in the juvenile justice system, service providers may benefit from incorporating small culturally sensitive techniques into clinical diagnostic interviews to help elicit truthful responses from ethnic minorities. Culturally sensitive clinical interviewing will lead to better identification of mental health problems, and eventually help aid in the creation of the most beneficial public health intervention plan for the juvenile offender. Specifically, for Mexican American juvenile offenders with English as a second language, it may be helpful for the juvenile offender to have the opportunity to report mental health symptomology in Spanish or even to speak with a service provider of the same ethnicity (Cauce et al., 2002).

References Abram, K. M., Teplin, L. A., McClelland, G. M., & Dulcan, M. K. (2003). Comorbid psychiatric disorders in youth in juvenile detention. Archives of General Psychiatry, 60, 1097–1108. http://dx.doi.org/10.1001/ archpsyc.60.11.1097 Alegría, M., Canino, G., Shrout, P. E., Woo, M., Duan, N., Vila, D., . . . Meng, X. L. (2008). Prevalence of mental illness in immigrant and

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

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non-immigrant U.S. Latino groups. The American Journal of Psychiatry, 165, 359 –369. http://dx.doi.org/10.1176/appi.ajp.2007.07040704 Almquist, L., & Dodd, E. (2009). Mental health courts: A guide to research-informed policy and practice. New York, NY: Council of State Governments, Justice Center. Alvidrez, J. (1999). Ethnic variations in mental health attitudes and service use among low-income African American, Latina, and European American young women. Community Health Journal, 35, 515–530. http://dx .doi.org/10.1023/A:1018759201290 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Publishing. Andrews, D. A., & Bonta, J. (2010). The psychology of criminal conduct. New Providence, NJ: Matthew Bender & Company. Andrews, D. A., Bonta, J., & Wormith, J. S. (2006). The recent past and near future of risk and/or need assessment. Crime and Delinquency, 52, 7–27. http://dx.doi.org/10.1177/0011128705281756 Arredondo, D. E., Kumli, K., Soto, L., Colin, E., Ornellas, J., Davilla, R. J., Jr., . . . Hyman, E. M. (2001). Juvenile mental health court: Rationale and protocols. Juvenile & Family Court Journal, 52, 1–19. http://dx.doi .org/10.1111/j.1755-6988.2001.tb00047.x Asnaani, A., Richey, J. A., Dimaite, R., Hinton, D. E., & Hofmann, S. G. (2010). A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. Journal of Nervous and Mental Disease, 198, 551–555. http://dx.doi.org/10.1097/NMD.0b013e3181ea169f Atkins, D. L., Pumariega, A. J., Rogers, K., Montgomery, L., Nybro, C., Jeffers, G., & Sease, F. (1999). Mental health and incarcerated youth: Prevalence and nature of psychopathology. Journal of Child and Family Studies, 8, 193–204. http://dx.doi.org/10.1023/A:1022040018365 Axelson, D., Birmaher, B., Zelazny, J., Kaufman, J., & Gill, M. K. (2009). Kiddie Schedule for Affective Disorders and Schizophrenia—Present and Lifetime Version. Retrieved from http://www.psychiatry.pitt.edu/ sites/default/files/Documents/assessments/KSADS-PL_2009_wor king_draft_full.pdf Banerjee, M., Capozzoli, M., McSweeney, L., & Sinha, D. (1999). Beyond kappa: A review of interrater agreement measures. The Canadian Journal of Statistics, 27, 3–23. http://dx.doi.org/10.2307/3315487 Becker, S. P., Kerig, P. K., Lim, J. Y., & Ezechukwu, R. N. (2012). Predictors of recidivism among delinquent youth: Interrelations among ethnicity, gender, age, mental health problems, and posttraumatic stress. Journal of Child & Adolescent Trauma, 5, 145–160. http://dx.doi.org/ 10.1080/19361521.2012.671798 Blazer, D. G., Kessler, R. C., McGonagle, K. A., & Swartz, M. S. (1994). The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. The American Journal of Psychiatry, 151, 979 –986. http://dx.doi.org/10.1176/ajp.151.7 .979 Bonta, J., & Andrews, D. A. (2007). Risk-need-responsivity model for offender assessment and rehabilitation. Rehabilitation, 6, 1–22. Retrieved from http://205.172.12.54/corrections/resources/Risk_Need Res ponsivity/Risk_Need_200706.pdf Burriss, F. A., Breland-Noble, A. M., Webster, J. L., & Soto, J. A. (2011). Juvenile mental health courts for adjudicated youth: Role implications for child and adolescent psychiatric mental health nurses. Journal of Child and Adolescent Psychiatric Nursing, 24, 114 –121. http://dx.doi .org/10.1111/j.1744-6171.2011.00276.x Bushe, C. J., Taylor, M., & Haukka, J. (2010). Mortality in schizophrenia: A measurable clinical endpoint. Journal of Psychopharmacology (Oxford, England), 24, 17–25. http://dx.doi.org/10.1177/135978 6810382468 Cauce, A. M., Domenech-Rodríguez, M., Paradise, M., Cochran, B. N., Shea, J. M., Srebnik, D., & Baydar, N. (2002). Cultural and contextual influences in mental health help seeking: A focus on ethnic minority

youth. Journal of Consulting and Clinical Psychology, 70, 44 –55. http://dx.doi.org/10.1037/0022-006X.70.1.44 Centers for Disease Control and Prevention. (2013, May 16). Mental health surveillance among children–United States, 2005–2011. MMWR 2013, 62, 1–35. Cocozza, J. J., & Skowyra, K. R. (2000). Youth with mental health disorders: Issues and emerging responses. Juvenile Justice, 7, 2–12. Retrieved from http://files.eric.ed.gov/fulltext/ED442030.pdf Cuellar, I., & Paniagua, F. A. (2000). Multicultural mental health. San Diego, CA: Academic Press. Dixon, A., Howie, P., & Starling, J. (2004). Psychopathology in female juvenile offenders. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 45, 1150 –1158. http://dx.doi.org/10.1111/j.14697610.2004.00307.x Duclos, C. W., Beals, J., Novins, D. K., Martin, C., Jewett, C. S., & Manson, S. M. (1998). Prevalence of common psychiatric disorders among American Indian adolescent detainees. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 866 – 873. http://dx .doi.org/10.1097/00004583-199808000-00017 Eno Louden, J., Kang, T., Ricks, E. P., & Marquez, L. (in press). Utility of the MAYSI-2 at identifying mental disorder among Latino juvenile offenders. Psychological Assessment. Gonzalez, G. M. (1997). The emergence of Chicanos in the twenty-first century: Implications for counseling, research, and policy. Journal of Multicultural Counseling and Development, 25, 94 –106. http://dx.doi .org/10.1002/j.2161-1912.1997.tb00320.x Grisso, T., & Barnum, R. (2006). Massachusetts Youth Screening Instrument-2 (MAYSI-2): User’s manual (rev. ed.). Sarasota, FL: Professional Resource Press. Grisso, T., & Underwood, L. A. (2004). Screening and assessing mental health and substance use disorders among youth in the juvenile justice system. Washington, DC: Office of Juvenile Justice and Delinquency Prevention. Retrieved from http://files.eric.ed.gov/fulltext/ED484681 .pdf Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2010). Monitoring the future: National survey results on drug use, 1975–2010 (Vol. 1, secondary school students). Ann Arbor, MI: Institute for Social Research, The University of Michigan. Kaufman, J., Birmaher, B., Brent, D., Rao, U., & Ryan, N. (1996). Kiddie-SADS-Present and Lifetime version (K-SADS-PL). Pittsburgh, PA: University of Pittsburgh, School of Medicine. Retrieved from http:// www.personal.psu.edu/lxr28/articles/b090.pdf Kleinman, A. (1988). Rethinking psychiatry. New York, NY: The Free Press. Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2013). Abnormal psychology (12th ed.). New York, NY: Wiley. McCabe, K. M., Lansing, A. E., Garland, A., & Hough, R. (2002). Gender differences in psychopathology, functional impairment, and familial risk factors among adjudicated delinquents. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 860 – 867. http://dx.doi.org/ 10.1097/00004583-200207000-00020 Redlich, A. D., Steadman, H. J., Monahan, J., Petrila, J., & Griffin, P. A. (2005). The second generation of mental health courts. Psychology, Public Policy, and Law, 11, 527–538. http://dx.doi.org/10.1037/10768971.11.4.527 Regier, D. A., Kuhl, E. A., & Kupfer, D. J. (2013). The DSM–5: Classification and criteria changes. World Psychiatry; Official Journal of the World Psychiatric Association, 12, 92–98. http://dx.doi.org/10.1002/wps .20050 Riolo, S. A., Nguyen, T. A., Greden, J. F., & King, C. A. (2005). Prevalence of depression by race/ethnicity: Findings from the National Health and Nutrition Examination Survey III. American Journal of Public Health, 95, 998 –1000. http://dx.doi.org/10.2105/AJPH.2004 .047225

This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

PREVALENCE OF DISORDERS Ruiz, P. (1985). Cultural barriers to effective medical care among Hispanic-American patients. Annual Review of Medicine, 36, 63–71. http://www.annualreviews.org/doi/pdf/ http://dx.doi.org/10.1146/ annurev.me.36.020185.000431. Satcher, D. (2000). Mental health: A report of the Surgeon General— Executive summary. Professional Psychology, Research and Practice, 31, 5– 49. http://dx.doi.org/10.1037/0735-7028.31.1.5 Schubert, C. A., Mulvey, E. P., & Glasheen, C. (2011). Influence of mental health and substance use problems and criminogenic risk on outcomes in serious juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 925–937. http://dx.doi.org/10.1016/j.jaac .2011.06.006 Semier, J. D. (1979). Child’s emotional health—The need for legal protection, A. Tulsa Law Journal, 15, 299 –326. Retrieved from http://0heinonline.org.lib.utep.edu/HOL/Print?handle⫽hein.journals/tlj15 &div⫽23&collection⫽journals&set_as_cursor⫽41&men_tab⫽sr chresults&terms⫽emotional|child|abuse&type⫽matchall Skeem, J. L., Manchak, S., & Peterson, J. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35, 110 –126. http://dx.doi .org/10.1007/s10979-010-9223-7 Skowyra, K. R., & Cocozza, J. J. (2007). Blueprint for change: A comprehensive model for the identification and treatment of youth with mental health needs in contact with the juvenile justice system (Report No. 2001-BR-JX-0001). Retrieved from http://www.ncmhjj.com/wpcontent/uploads/2013/07/2007_Blueprint-for-Change-Full Report.pdf Teplin, L. A., Abram, K. M., McClelland, G. M., Dulcan, M. K., & Mericle, A. A. (2002). Psychiatric disorders in youth in juvenile detention. Archives of General Psychiatry, 59, 1133–1143. http://dx.doi.org/ 10.1001/archpsyc.59.12.1133 Underwood, L. A., & Washington, A. (2016). Mental illness and juvenile offenders. International Journal of Environmental Research and Public Health, 13, 228. http://dx.doi.org/10.3390/ijerph13020228 Urdaneta, M., Saldaña, D., & Winkler, A. (1995). Mexican-American perceptions of severe mental illness. Human Organization, 54, 70 –77. http://dx.doi.org/10.17730/humo.54.1.e216p6442857477q U.S. Census Bureau. (2014). County population estimates by age, sex, race and Hispanic in El Paso County, TX. Retrieved from http://www.txcip .org/tac/census/profile.php?FIPS⫽48141. U.S. Department of Justice. (1999). Mental health and treatment of inmates and probationers (NCJ Report No. 174463). Washington, DC: U.S. Department of Justice, Office of Justice Programs.

9

Van Damme, L., Colins, O. F., & Vanderplasschen, W. (2014). Gender differences in psychiatric disorders and clusters of self-esteem among detained adolescents. Psychiatry Research, 220, 991–997. http://dx.doi .org/10.1016/j.psychres.2014.10.012 Vega, W. A., & Alegría, M. (2001). Latino mental health and treatment in the United States. In M. Aguirre-Molina, C. W. Molina, & R. E. Zambrana (Eds.), Health issues in the Latino community (pp. 179 –210). San Francisco, CA: Wiley. Wasserman, G. A., McReynolds, L. S., Ko, S. J., Katz, L. M., & Carpenter, J. R. (2005). Gender differences in psychiatric disorders at juvenile probation intake. American Journal of Public Health, 95, 131–137. http://dx.doi.org/10.2105/AJPH.2003.024737 Wasserman, G. A., McReynolds, L. S., Ko, S. J., Katz, L. M., Cauffman, E., Haxton, W., & Lucas, C. P. (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. http://dx.doi.org/10.1097/00004583200405000-00017 Wasserman, G. A., McReynolds, L. S., Lucas, C. P., Fisher, P., & Santos, L. (2002). The voice DISC-IV with incarcerated male youths: Prevalence of disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 314 –321. http://dx.doi.org/10.1097/ 00004583-200203000-00011 Watson, A., Hanrahan, P., Luchins, D., & Lurigio, A. (2001). Mental health courts and the complex issue of mentally ill offenders. Psychiatric Services, 52, 477– 481. http://dx.doi.org/10.1176/appi.ps.52.4.477 Wierson, M., & Forehand, R. (1995). Predicting recidivism in juvenile delinquents: The role of mental health diagnoses and the qualification of conclusions by race. Behaviour Research and Therapy, 33, 63– 67. http://dx.doi.org/10.1016/0005-7967(94)E0001-Y Wright, E. M., Salisbury, E. J., & Van Voorhis, P. (2007). Predicting the prison misconducts of women offenders: The importance of genderresponsive needs. Journal of Contemporary Criminal Justice, 23, 310 – 340. http://dx.doi.org/10.1177/1043986207309595

Received November 7, 2016 Revision received January 26, 2017 Accepted January 31, 2017 䡲