Treatment Services in the Juvenile Justice System: Examining the Use and Funding of Services by Youth on Probation

Abstract

Youth enter the juvenile justice system with a variety of service needs, particularly for mental health problems. Research has examined the extent to which youth have mental health disorders, primarily among detained youth, and factors associated with treatment referrals, but little research has examined youth on probation and the actual use of services. Using data obtained from the Maricopa County Juvenile Probation Department from July 2012 through August 2014 (N = 3,779), the current study examines (1) the factors associated with receiving treatment services while on probation and (2) the factors associated with receiving treatment services through different funding streams. Findings reveal that only about 25% of the sample of youth on probation received treatment services, suggesting the underservicing of youth. Consistent with prior research, there were also racial and ethnic disparities concerning treatment use, with Blacks and Latinos less likely to receive services. Additionally, certain characteristics of youth and their background influenced the funding source for treatment services. Implications for policy and research are discussed in light of these findings.

Keywords

probation treatment services service use juvenile justice racial/ethnic disparities

The juvenile justice system has multiple responsibilities often serving conflicting goals of punitive sanctions and rehabilitative treatment (Bishop, 2006; Lipsey, Howell, Kelly, Chapman, & Carver, 2010). The system must not only address the current delinquent behavior but also, in many cases, consider the health and well-being of the youth. Youth come into the juvenile justice system with more complex problems and greater needs for mental and behavioral health services, which has resulted in more attention on efforts to rehabilitate and address youth’s mental and behavioral service needs (Myers & Farrell, 2008). Research has examined a number of issues related to mental health and behavioral health problems of youth in the juvenile justice system, particularly identifying the rates of mental health problems and service needs among youth and factors associated with treatment referrals of youth in different systems of care (i.e., juvenile justice system and mental health system).

Research on mental health problems in justice-involved youth has primarily focused on the service needs of youth and where they have been referred to meet these needs and not on whether they actually received those services. Additionally, much of the work examines youth in detention or compares youth sentenced to community versus correctional supervision rather than youth on probation which is the predominate sentence in the juvenile justice system. The current study uses juvenile probation data from a large, urban jurisdiction in Arizona to examine these issues. More specifically, legal and extralegal factors associated with the use of treatment services among youth on probation supervision are examined. Furthermore, the extent to which services are funded by the juvenile justice system has not been empirically examined, therefore, whether these services are funded by the juvenile justice system or external funding sources such as Medicaid or private insurance is also examined.

Unmet Service Needs and Treatment Referrals

Youth involved in the juvenile justice system often experience multiple adversities or risk factors, such as economic disadvantage, experiences of abuse and neglect, unstable family environments, exposure to drugs and alcohol, and mental illness (Esbensen, Peterson, & Taylor, 2010; Huizinga, Loeber, Thornberry, & Cothern, 2000; Loeber & Farrington, 1998). Research has generally found that 65–70% of youth in juvenile justice facilities, primarily detention centers and correctional facilities, suffer from at least one mental health disorder (Shufelt & Cocozza, 2006; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002; Wasserman, McReynolds, Lucas, Fisher, & Santos, 2002), while rates among youth on probation are approximately 50% (Wasserman, McReynolds, Ko, Katz, & Carpenter, 2005).

Additionally, comorbidity, or the presence of more than one mental or behavioral disorder, is particularly high among youth in juvenile justice settings (Abram, Teplin, McClelland, & Dulcan, 2003; Kessler et al., 1996; Teplin et al., 2002). Shufelt and Cocozza (2006) found that roughly 79% of those who met criteria for at least one mental health disorder had two or more diagnoses. Unfortunately, many of these mental and behavioral service needs are not met in the community (Flisher et al., 1997; Jensen et al., 2011; Kataoka, Zhang, & Wells, 2002; Ringel & Sturm, 2001). As a result, the coexistence of multiple disorders in addition to other criminogenic risk factors makes prioritizing mental and behavioral service needs more challenging for the juvenile justice system (Grisso, 2004).

Research has examined factors related to unmet service needs and the avenues through which youths’ mental health needs are met through various service sectors, such as the mental health system and juvenile justice system (Burns et al., 2004; Stahmer et al., 2005; Thompson, 2005). Among the general population, children and adolescents with mental and behavioral health problems are gravely undertreated with high rates of unmet service needs (Angold et al., 1998; Flisher et al., 1997; Horwitz, Gary, Briggs-Gowan, & Carter, 2003). Studies have examined characteristics of children with unmet mental health needs and their families using various samples to identify key predictors of treatment service use and unmet service needs.

Among the primary factors associated with unmet service needs are elements related to economic disadvantage such as living on public assistance, lack of health insurance, and transportation problems (Chow, Jaffee, & Snowden, 2003; Cornelius, Pringle, Jernigan, Kirisci, & Clark, 2001; Haines, McMunn, Nazroo, & Kelly, 2002). Race and ethnicity are also strong predictors of unmet service needs with Whites being more likely to receive mental health services compared to minorities (Angold et al., 2002; Garland et al., 2005; Kataoka et al., 2002; Thompson, 2005; Yeh, McCabe, Hough, Dupuis, & Hazen, 2003). Studies have also found that minorities have limited opportunities to access mental health services (Arcia, Keyes, Gallagher, & Herrick, 1993), and once they start treatment they are less likely to complete treatment (Kazdin, Stolar, & Marciano, 1995).

Research has also found involvement in the mental health system increases the likelihood of being referred to the juvenile justice system (Cohen et al., 1990; Evens & Stoep, 1997; Rosenblatt, Rosenblatt, & Biggs, 2000). In addition, younger adolescents, females, and White youths are more likely to be referred to the mental health system, while minorities, males, and youths with more serious and disruptive mental health disorders are more likely to be referred to the juvenile justice system (Atkins et al., 1999; Cohen et al., 1990; Dembo, Turner, Borden, & Schmeidler, 1994; Evens & Stoep, 1997). In general, service needs of disadvantaged and minority youth are often not recognized until their contact with the juvenile justice system (Golzari, Hunt, & Anoshiravani, 2006; Rawal, Romansky, Jenuwine, & Lyons, 2004; Rogers, Pumariega, Atkins, & Cuffe, 2006).

Upon entering the juvenile justice system, service needs often continue to go unmet even after identification of need for treatment (Rogers, Zima, Powell, & Pumariega, 2001; Shelton, 2005). Shelton (2005) found that only 23% of youth diagnosed with mental health disorders received treatment and that having a mental disorder was not a significant predictor of receiving services. A recent study conducted by Hoeve, McReynolds, and Wasserman (2014) found that youth with externalizing disorders and substance use disorders were more likely to receive referrals, while only 40% of youth with internalizing disorders referred to service. Consistent with the findings from the general public, Whites are more likely to be referred to services compared to Black youth in the justice system (Dalton, Evans, Cruise, Feinstein, & Kendrick, 2009; Lopez-Williams, Stoep, Kuro, & Stewart, 2006; Maschi, Hatcher, Schwalbe, & Rosato, 2008; Rogers et al., 2006), but there are some mixed findings (Breda, 2003; Hoeve et al., 2014). Shelton (2005) concluded that
while the total responsibility for the well-being of children does not lie solely with the juvenile justice system, the decision not to provide treatment services to youth in need and under their care implies neglect…it implies a perception that these youth will go away, be treated elsewhere, or grow out of their problems. (p. 110)
These prior studies do not provide a clear set of predictors for service referrals and many studies were not able to control for offense severity and criminal history (Dalton et al., 2009; Lopez-Williams et al., 2006; Rawal et al., 2004), which are likely to influence referrals for services. Regardless, there were discrepancies in service referrals in the juvenile justice system. Receipt of service referrals was not found to be dependent entirely on the need for services but may be influenced by other factors that create disparities in the health of youth. Furthermore, these studies did not take into account access (i.e., availability, health insurance, etc.) to referred services or whether youth were actually using the services.

Many of the studies previously discussed use referrals for treatment services as the outcome of interest, but little research has examined the actual receipt or use of treatment services by youth (Teplin, Abram, McClelland, Washburn, & Pikus, 2005). Teplin, Abram, McClelland, Washburn, and Pikus (2005) found that roughly 16% of youth who had been identified as needing mental health services during detention received services within 6 months from detention or by disposition. Additionally, 11% of youths received services but did not meet the definition of need. Johnson et al. (2004) examined substance abuse treatment need and use among youth entering juvenile corrections and found that nearly half of youth with need for substance abuse treatment received services. Rawal, Romansky, Jenuwine, and Lyons (2004) examined racial differences in mental health needs and service use among incarcerated youth. The authors found that Blacks had the greatest level of mental health needs, but the lowest level of prior and current service use. In general, these studies emphasize how few individuals actually receive services for their mental and behavioral service needs as well as the “benign neglect” of the juvenile justice system in addressing mental and behavioral service needs (Herz, 2001).

Lastly, receiving referrals for treatment or participating in certain programs and treatment does not necessarily translate into needs being met (Grisso, 2004). The justice system has the difficult task of distinguishing youths’ need for specific programs that target criminogenic risk factors from the need for treatment services that address their overall mental well-being. Given limited training and resources, some needs are often prioritized over others, leaving other needs unaddressed (Haqanee, Peterson-Badali, & Skilling, 2015). Responsivity is a key component of the risk-needs-responsivity (RNR) model in offender treatment, emphasizing matching program and treatment plans to meet the unique reoffending risks and risk factors (i.e., criminogenic needs) of offenders through evidence-based rehabilitative programs that are tailored to an individual’s strengths and capacities (Andrews & Bonta, 2010; Andrews, Bonta, & Hoge, 1990; Hoge & Andrews, 1996). Rather than general mental health (GMH) care, the RNR model is focused on reducing future delinquency and recidivism but has been criticized for not addressing more basic, noncriminogenic, human needs, such as mental health (T. Ward & Stewart, 2003; T. Ward, Yates, & Willis, 2012). Additionally, treating mental health and substance abuse disorders may or may not address other criminogenic risk factors and prevent future delinquency (see Wibbelink, Hoeve, Stams, & Oort, 2017) but may have implications for youths’ responsiveness to treatment goals and success in addressing criminogenic needs (Haqanee et al., 2015). Nevertheless, programs that adhere to the principles of RNR have been successful in reducing recidivism (Andrews & Bonta, 2010).

One of the primary RNR assessment tools, the Youth Level of Service/Case Management Inventory (YLS/CMI), has been validated for its ability to predict recidivism among youth (Catchpole & Gretton, 2003; Jung & Rawana, 1999; Onifade et al., 2008; Vieira, Skilling, & Peterson-Badali, 2009). However, agencies and practitioners face many challenges to develop clear treatment plans and effectively implement services despite identifying risks and needs through assessment (Flores, Travis, & Latessa, 2004; Latessa, Cullen, & Gendreau, 2002; Sutherland, 2009), resulting in many youths’ needs left unaddressed (Vieira et al., 2009). This “implementation gap” is often the result in the availability of quality, evidence-based programming, such as cognitive behavioral therapy (Haqanee et al., 2015). For example, Flores, Travis, and Latessa (2004) found in one state jurisdiction that the RNR tool (YLS/CMI) was widely used, but when it came to services in the treatment plans, they rarely targeted the needs identified in the assessment. In sum, there have been great strides in recognizing and measuring criminogenic risks and needs that when addressed can improve outcomes for youth. Mental illness, however, is often not considered one of those criminogenic needs (Haqanee et al., 2015), so practitioners may continue to use their clinical judgment and experience over the use of risk assessment tools (C. Schwalbe, 2004), and services received may not target the needs/risks identified.

Funding Treatment Services

While the juvenile justice system has a legal mandate to provide treatment services, it does not have to be the one to administer that care (Grisso, 2004). When a youth is required to receive court-ordered treatment services as a condition of probation supervision, there are multiple avenues or sources of funding that can pay for these services. If the youth has no means (i.e., health insurance) to pay for treatment services ordered by the court, the juvenile justice system has a financial responsibility to fund the treatment services it is requiring.

The juvenile justice system has used outside agencies and external funds to reduce the burden of providing treatment services—they typically contract out to private providers or other government agencies such as public mental health service providers. Similarly, the treatment services can be funded through different sources such as private insurance or public health care, but if those avenues are not available, the juvenile justice system is responsible to fund the treatment services. Families of youth in the juvenile justice system often have limited knowledge and resources to navigate the health-care system; therefore, youth often are more likely to be uninsured and their mental and behavioral conditions are not addressed. Furthermore, services provided through Medicaid are often restricted to children with the most severe mental disorders due to lack of funding (Kerker & Dore, 2006). As a result, children with less serious problems are often ineligible for services and those who do qualify receive inconsistent and fragmented care. Finally, studies have found that lack of health insurance is a major impediment to obtaining mental and behavioral health services (Farmer, Stangl, Burns, Costello, & Angold, 1999; Flisher et al., 1997; Kataoka et al., 2002).

In light of the health-care debate, the current research also speaks to the issue of funding and resources for mental health care and substance use disorder services that are often subject to social, political, and economic influence. The coverage for mental health and substance use disorders by insurance companies and the availability and eligibility of Medicaid will likely have implications for practices in the juvenile justice system and the extent to which treatment services are court-funded. If youth have alternative sources to pay for treatment services, such as private insurance or Medicaid, the juvenile justice system will be relieved of that responsibility. While the current research does not empirically evaluate health-care reform on funding treatment services in the juvenile justice system, findings should be considered in the context of these broader changes.

The funding of treatment services in the juvenile justice system has not been examined as a key variable of interest. While the source of funding for treatment services is often determined by the youth’s health care coverage, the court also considers the need for services, prioritizing those with greatest need. However, as was demonstrated with literature on unmet service needs, need does not necessarily result in the expected outcomes (i.e., services). Following this line of thought, there may be other factors that could influence the court’s decision to fund treatment services. Furthermore, the quality of services and degree of investment the court has when it is funding the treatment services may differ, which may have implications for the future delinquent behavior and overall health of the youth.

Current Focus

Building on previous research on service needs and use among youth with mental and behavioral problems, this research examined treatment services received by youth involved in the Maricopa County Juvenile Probation Department (MCJPD). The court serves youth by requiring treatment services for mental and behavioral problems but providing resources to pay for treatment services adds an additional level of intervention and investment in these youth’s lives. The current research examined characteristics of youth who received treatment services as well as funding sources for services. More specifically, two research questions are examined:

Research Question 1: What are the predictors (e.g., gender, race, delinquent background, etc.) associated with receiving treatment services under probation supervision?

Research Question 2: Among youth receiving treatment services, what are the predictors associated with the source of funding for treatment services; specifically, what are the predictors of receiving treatment services via external funding sources relative to court-based funding?

Research on mental and behavioral service needs and service referrals has generally focused on treatment for mental health and substance use disorders, but youth can have other service needs. The current research is not restricted to mental health and substance use treatment services and is more inclusive of other treatment services provided by the juvenile justice system, such as behavior-specific education, mentoring programs, and evidence-based programs. Based on previous research, we expect race/ethnicity to be a strong predictor of service use as well as prior history of mental health problems and involvement in the juvenile justice system.

This research will also shed light on which types of services are typically funded by the court. The ever-changing financial climate and the health-care debate provide a broader context that can help inform the importance of understanding the sources of funding for treatment services. There is growing concern for addressing service needs, particularly for mental health and substance use disorders, but with limited resources, the funding sources of treatment services deserves empirical attention. Given the limited attention on the issue of funding, this question is more exploratory in nature. The implications of this research will help to inform broader issues of the juvenile justice system’s obligation to provide treatment.

Method

Data and Sample

The MCJPD and the Treatment Services Division were sources for data regarding youth receiving treatment services. The time frame for the data spanned a 25-month period beginning July 1, 2012, to August 31, 2014, during which a total of 4,244 youth were placed on probation, 60 of whom had multiple probations during the time frame.¹ The data were compiled onsite with the assistance from the Research and Planning Division of the MCJPD. A data sharing agreement was obtained with institutional review board approval to receive deidentified youth information through electronic databases. With the exception of certain files, such as psychological case notes,² MCJPD uses the integrated court information system to manage youths’ records, and Microsoft^® Access was used to query databases associated with youth who were placed under probation supervision during the specified time frame.³

For purposes of this analysis, the unit of analysis was the individual youth. Eight different databases were used to measure the legal and extralegal characteristics of the youth and their case. The databases were cleaned as separate files and merged based on each youth’s unique identifier. The data required recoding variables and MCJPD advised to ensure the recoded variables accurately measured the correct information. For example, the complaint data set contained all referrals (or complaints) the youth has received in Maricopa County. The unit of analysis in this data set was referrals, and there were 17,784 referrals for the 4,244 youth analyzed in the current research. This data set, in particular, took an extensive amount of cleaning and management because it was used to (1) identify which referral was associated with the disposition that placed the youth on probation and the severity of that offense, and (2) determine the number of referrals and adjudications that occurred before the current probation to measure prior offending behavior.

The final sample of youths on probation was 3,779 after those with short probation periods (less than 10 days) and cases with missing data were removed.⁴ Descriptive statistics of the sample of youth are presented in Table 1. Similar to other research on juvenile justice populations, a majority of the sample was male (81.2%), roughly 37% of the sample were White, 15% Black, and 41% Hispanic, and the mean age was 16.1 years old. A majority of the youth came from single parent living situations (60.8%) and a quarter were not enrolled in school. In regard to the youths’ offense and juvenile justice history, property felonies were the most common (25.1%), followed by personal felonies (19.1%), 40.5% were detained prior to adjudication, 67.1% had a prior referral, and 12.9% had a prior adjudication. Additionally, 37.5% of youth received a psychological evaluation associated with the current offense, 18.3% had prior treatment services, and in regard to risk level, 20.4% were low, 24.6% were moderate, and 55% were high risk.

Table 1.
Descriptive Statistics of Dependent and Independent Variables.

Variables Youth on Probation (N = 3,779)

% n

Outcome variables

Receiving treatment services 25.0 944

Funding source (n = 861)

Court-based 72.2 622

External 27.8 239

Independent variables

Gender

Female (reference) 18.8 712

Male 81.2 3,067

Race/ethnicity

White (reference) 37.4 1,414

Black 15.3 580

Latino 41.4 1,564

Native American 4.3 161

Other 1.6 60

Age (mean) 16.1 (1.3) 3,779

Living situation

Single parent (reference) 60.8 2,299

Two parents 19.6 741

Grandparents or other relatives 8.3 313

DCS and other 11.3 198

School status

Enrolled (reference) 75.1 2,839

Not enrolled 24.9 940

Offense severity

Property felony (reference) 25.1 948

Personal felony 19.1 720

Property misdemeanor 12.6 477

Personal misdemeanor 8.0 304

Drugs 18.8 710

Public peace 14.8 559

Other 1.6 61

Preadjudication detention 40.5 1,530

Prior referral 67.1 2,537

Prior adjudication 12.9 486

Psychological evaluation 37.5 1,416

Prior treatment services 18.3 692

Risk level

Low (reference) 20.4 770

Moderate 24.6 929

High 55.0 2,080

Note. DCS = Department of Child Services.

The current research focused on youth who received treatment services in the community and residential facilities while on probation, thus services received while on diversion will not be examined, but will be captured as prior services. In 2012, MCJPD began the Service Authorization Form Automation Project to electronically track the treatment services ordered by the court and progress of youth receiving services as part of their probation. Based on the recommendation by Research and Planning Division, services that started 90 days prior to the start of probation will also be considered prior services. Treatment services evaluated in the current study include GMH services, sex offender services, substance abuse services, mentoring or life skills programs, behavior-specific education, evidence-based programs, and drug court services.⁵ Treatment services that are not included in the current research include mandatory drug testing, detention alternative programs, physical health services such as acute care or hospitalization, polygraph examinations, and assessments. These services were not included because they are not therapeutic in nature and generally not used to address mental and behavioral service needs. Among the 3,779 youth on probation included in the analysis, 944 (25%) received the services of interest.

Measures

There are a number of legal and extralegal factors that have been examined in relation to various outcomes in the juvenile justice system and whether youth end up in mental health system versus juvenile justice system (Cohen et al., 1990; Evens & Stoep, 1997; Lyons, Baerger, Quigley, Erlich, & Griffin, 2001; Thomas & Stubbe, 1996). The current study focused on the referral that placed the youth on the current probation and treatment services, but characteristics of prior behavior are captured. The independent variables that were used in the analyses include gender, race, ethnicity, age, living situation, school status, offense severity, preadjudication detention, prior referrals, prior adjudications, whether the youth received a psychological evaluation, prior treatment service use, and risk assessment level.

Gender was coded as 1 for males and 0 for females, and race and ethnicity are measured by several dummy variables: Blacks, Latino/Latina, and other race/ethnicity, with White as the reference category. Age is measured as the age of the youth at the time of the referral that received a disposition of treatment services and is measured continuously. The living situation of the youth captured who the youth lived with when they were placed on probation. The categories included single parent, two parents, grandparents or other relative, and Department of Child Safety or other, with single parent serving as the reference category. School status was measured on the basis of whether or not the youth was enrolled in school during the time of the current referral. Offense severity captured the most severe offense associated with the referral. Consistent with sentencing research on juveniles, if the youth was charged with multiple offenses, the most serious offense was measured. There are seven categories of offense severity—property felony, personal felony, property misdemeanor, personal misdemeanor, drugs, public peace, and other offenses that included obstructions of justice and status offenses. Property felony serves as the reference category because it had the highest frequency. Preadjudication detention captured whether the youth was detained prior to adjudication for the current offense and probation. Prior referrals and prior adjudications are measured dichotomously, with “yes/no” outcomes. Prior service use was also a binary variable, measuring whether the youth has received treatment services through the court from either diversion or prior probations.

Every youth who reaches adjudication and disposition is considered for a psychological evaluation, but these are predominately conducted only when there is a history of mental illness and service need, and the court would benefit from clinical assistance. Therefore, having a psychological assessment is a strong proxy for history of mental health problems in the current study. In addition to the psychological evaluation, every youth completes the Arizona risk/needs assessment (ARNA) and receives a risk level—low, moderate, or high. ARNA is an empirically validated instrument predominately used to predict risk of future offending, but it also helps in identifying needs of youth (see Krysik & LeCroy, 2002; C. S. Schwalbe, 2009). Following the youth’s initial intake assessment that includes an interview with the youth and a review of records, the risk assessment items are completed by two probation officers. The risk scale consists of a number of dimensions such as alcohol and drug use, family relationship, assaultive behavior, extensive absenteeism or truancy at school, peer delinquency, and emotional/behavioral problems.

The type of treatment service was also included as an independent variable for examining the second dependent variable (source of funding) to control for services that are typically provided and therefore funded by the court. As previously mentioned, the services youth could receive were: GMH—residential and outpatient, sex offender—residential and outpatient, and substance abuse—residential or outpatient, as well as mentoring and life skills, behavior-specific education, evidence-based programs, and drug court services (see Appendix A). The most common type of treatment service used was GMH outpatient services (29.9%) followed by residential GMH services (19.9%). Mentoring services, behavior-specific education, evidence-based programs, and drug court services were combined into one category because of their low frequency and they were predominately funded and administered through MCJPD. Additionally, 247 youth received multiple services, so these were divided into youth who received two services and youth who received three or more services. The reference category for type of service was youth who exclusively received GMH outpatient services.

Dependent Variables

There are two primary dependent variables that were examined in the current analysis: (1) whether the youth received treatment services and (2) the type of funding source for treatment services. First, to examine predictors of receiving treatment services, the dependent variable was a dichotomous outcome of whether the youth received court-ordered treatment services (coded as 1) or not (coded as 0). Much of the prior research examines referrals for treatment services, which can often act as a proxy for receiving services, but since this study can identify referrals that result in the use of treatment service, referrals for that were denied were coded as zero.

Second, to examine the next research question pertaining to the funding source for treatment sources, the source of funding was coded as a dichotomous outcome. Given limited resources, every youth is screened for behavioral health coverage through the state Medicaid fund, Arizona Health Care Cost Containment System (AHCCCS) or Regional Behavioral Health Authorities (RBHA), and/or private insurance (Superior Court of Maricopa County, Juvenile Probation Department, 2015). If the youth does not receive benefits from the private or public insurance, the youth’s treatment services are funded by the court through the Juvenile Probation Services Fund. Only seven youth in the sample received treatment services through private insurance, so this category was not large enough to analyze separately. Additionally, 16 youth received treatment services through tribal health coverage, 90 through RBHA, and 86 through AHCCCS. These funding sources were combined into one category of external funding source (coded as 1), which is compared to court-based funding as the reference category (coded as 0) for the multivariate analysis.⁶

Analytic Strategy

The analysis will proceed in two stages. First, bivariate statistics will be estimated to identify differences between groups using independent sample t tests and χ² to test for significance. The second stage of the analysis involves multivariate regression models. A logistic regression model was used to examine whether the youth received treatment services, and a two-stage full information maximum likelihood (FIML) probit model was estimated to control for selection bias when examining the funding source dependent variable.⁷ Significant variables are reported in odds ratio (OR) for easier interpretation.

Results

Use of Services

Beginning with the first question of interest, examining factors associated with the receipt of treatment services, the bivariate statistics describing the relationship between the independent variables and whether the youth received treatment services are presented in Table 2. As indicated by Table 2, there was not a significant relationship between gender and receiving treatment services, but there was a significant difference for race/ethnicity, with Latino youth were slightly underrepresented in treatment services compared to the other groups and Native Americans more represented in treatment services.

Table 2.
Bivariate Statistics—Youth Receiving Treatment Services.

Variables No Treatment Services Treatment Services

% %

Gender

Female (reference) 76.1 23.9

Male 74.8 25.2

Race/ethnicity*

White (reference) 73.2 26.8

Black 73.6 26.4

Latino 77.4 22.6

Native American 71.4 28.6

Other 80.0 20.0

Age (mean, SD)* 16.2 (0.02) 15.6 (0.04)

Living situation*

Single parent (reference) 78.2 21.8

Two parents 80.0 20.0

Grandparent or other family 69.3 30.7

Other-DCS 53.5 46.5

School enrollment^†

Enrolled in school (reference) 74.3 25.7

Not enrolled in school 77.2 22.8

Offense severity*

Property felony (reference) 78.0 22.0

Personal felony 59.7 40.3

Property misdemeanor 82.2 17.8

Personal misdemeanor 73.7 26.3

Drugs 78.7 21.3

Public peace 78.9 21.1

Other 82.0 18.0

Preadjudication detention*

Not detained (reference) 77.0 23.0

Detained 72.2 27.8

Prior referral

No prior referrals (reference) 74.1 25.9

Prior referral 74.5 24.5

Prior adjudication*

No prior adjudications (reference) 73.9 26.1

Prior adjudications 82.5 17.5

Psychological evaluation*

No psychological evaluation (reference) 87.9 12.1

Psychological evaluation 53.5 46.5

Prior treatment service

No prior treatment services (reference) 75.8 24.2

Prior treatment services 71.5 28.5

Risk level*

Low (reference) 78.4 21.6

Moderate 77.3 22.7

High 72.7 27.3

N 2,835 944

Note. N = 3,779. Continuous measures were examined using a t-test and categorical variables were examined using a χ² test. SD = standard deviation; DCS = Department of Child Services.

p ≤ .05. p ≤ .01.p ≤ .001. ^†p ≤ .1.

While the mean age of the youth also was statistically different across treatment service use, with youth who received treatment services being slightly younger, the difference has little substantive or practical meaning. There were also significant differences between youths’ living situation, and offense severity, preadjudication detention, prior adjudication, psychological evaluation, prior treatment service use, and risk level. Youth who lived with parents, particularly two parents, were least likely to receive treatment services. Importantly, 46.5% of youth who received a psychological evaluation received treatment services, and 12.1% of youth who did not receive a psychological evaluation received services. This finding suggests a disconnect between need and use; while youth with a psychological evaluation were more likely to get treatment services, there were many youth who did not receive services. On the other end, a small number of youth received services without having a psychological evaluation.

The results from a multivariate logistic regression are presented in Table 3. The significant demographics included age, being Black or Latino, living with grandparents or relatives, and living with the state (Department of Child Services [DCS]) or other living arrangements. More specifically, the effect of age is negative, meaning that as age increases the likelihood of receiving treatment services decreases. In regard to race and ethnicity, Blacks and Latinos are less likely to receive treatment services than their White counterparts, 33.4% (OR = .666) and 21.9% (OR = .781), respectively. In terms of the youth’s living situation, youth who live with grandparents or relatives or DCS were more likely to receive treatment services than youth living with single parents. Specifically, youth under DCS care were more than 2 times (OR = 2.032) more likely to receive treatment services. There was no significant difference between youth who lived with two parents versus youth who lived with a single parent on the likelihood of receiving services.

Table 3.
Logistic Regression Predicting Youth Receiving Treatment Services.

Variables b SE Exp(b)

Male 0.106 .109 —

Age −0.226* .033 0.797

Race/ethnicity

Black −0.407 .130 0.666

Latino(a) −0.247** .097 0.781

Native American −0.088 .207 —

Other −0.299 .367 —

Living situation

Two parents 0.029 .114 —

Grandparents or relatives 0.296* .147 1.345

DCS and other 0.709* .126 2.032

Not enrolled in school^† −0.129 .105 —

Offense severity

Felony person 0.601* .125 1.824

Misdemeanor property −0.289 .162 —

Misdemeanor person 0.014 .172 —

Drugs 0.042 .137 —

Public peace 0.175 .145 —

Other −0.116 .363 —

Preadjudication detention −0.261 .095 0.770

Prior referral −0.121 .121 —

Prior adjudication −0.494* .144 0.610

Psychological evaluation 1.647*** .092 5.189

Prior treatment service 0.131 .111 —

Risk level

Moderate 0.035 .137 —

High 0.351* .149 1.036

Constant 1.585** .543 —

Log-likelihood −1,754.29

Pseudo R ² .1748

Note. N = 3,779. DCS = Department of Child Services; SE = standard error.

p ≤ .05. p ≤ .01.p ≤ .001. ^†p ≤ .1.

Other significant variables included preadjudication detention, prior adjudication psychological evaluation, and risk level. Both the effect of being detained and having a prior adjudication reduced the likelihood of receiving treatment services, 23% (OR = .770) and 39% (OR = .610), respectively. Finally, youth who had a psychological evaluation were more than 5 times more likely (OR = 5.189) to receive treatment services, and high risk youth were 3.6% (OR = 1.036) more likely to receive treatment services. Many of these findings are in expected directions and consistent with prior research, which will be explored in greater depth in the discussion.

Source of Funding

The second dependent variable examined was the source of funding for the treatment services youth on probation received, particularly whether certain characteristics of youth influence whether they receive treatment services through external funding, exclusively, compared to court-based funding. The bivariate results comparing the three funding sources are presented in Table 4. Regarding statistically significant differences across court-based and external funding, race/ethnicity, living situation, offense severity, preadjudication detention, psychological evaluation, risk level, and the type of treatment service had a statistically significant relationship with the source of funding for the treatment services. In regard to race and ethnicity, Native Americans in particular were more likely to get external funding (70%), whereas the other groups were more similar in the use of external funding.

Table 4.
Bivariate Statistics—Source of Funding for Treatment Services.

Variables Court Based % External %

Gender^†

Female 66.4 33.6

Male 73.5 26.5

Race/ethnicity*

White (reference) 76.3 23.7

Black 68.8 31.2

Latino 75.2 24.8

Native American 30.0 70.0

Other 54.5 45.5

Age—mean (SD) 15.7 (0.05) 15.3 (0.09)

Living with*

Two parents (reference) 80.8 19.2

Single parent 89.9 10.1

Grandparent or other family 74.7 25.3

Other-DCS 33.1 66.9

School enrollment

Enrolled in school (reference) 71.4 28.6

Not enrolled in school 74.9 25.1

Offense severity*

Property felony(reference) 73.0 27.0

Personal felony 70.9 29.1

Property misdemeanor 58.2 41.8

Personal misdemeanor 58.7 41.3

Drugs 78.1 21.9

Public peace 86.3 13.7

Other 80.0 20.0

Preadjudication detention

Not detained (reference) 76.4 23.6

Detained 67.1 32.9

Prior referral^†

No prior referrals (reference) 76.2 23.8

Prior referral 70.2 29.8

Prior adjudication

No prior adjudications (reference) 72.3 27.7

Prior adjudications 71.4 28.6

Psychological evaluation

No psychological evaluation (reference) 79.1 20.9

Psychological evaluation 69.0 31.0

Prior treatment service^†

No prior treatment services (reference) 73.6 26.4

Prior treatment services 67.2 32.8

Risk level*

Low (reference) 86.3 13.7

Moderate 68.2 31.8

High 69.6 30.4

Exclusive type of treatment service***

GMH outpatient (reference) 65.1 34.9

GMH residential 19.6 80.4

Sex offender outpatient 85.4 14.6

Sex offender residential 45.1 54.9

Substance abuse outpatient 85.3 14.7

Substance abuse residential 9.1 90.9

Other services 97.9 2.1

Two services 86.7 13.3

Three or more services 92.5 7.5

Note. n = 861. Continuous measures were examined using a t test and categorical variables were examined using a χ² test. MH = general mental health; SD = standard deviation; DCS = Department of Child Services.

p ≤ .05. p ≤ .01. p ≤ .001. ^†p ≤ .1.

One of the most notable differences between the two sources of funding was the youth’s living situation. Roughly 75% of youth who lived with grandparents or other family, over 80% of youth who live with two parents, and almost 90% of youth living with one parent received funding through the court, whereas 67% of youth who lived in other living situations such as State were funded externally. Regarding preadjudication detention, youth who were detained were more likely to receive treatment services through external funding rather than court based. Youth who had a psychological evaluation were more likely to receive treatment services via external funding, whereas youth who did not have a psychological evaluation were more likely to have their treatment services funded by the court. Low risk youth were also more likely to receive court-based funding for treatment services.

Finally, there were differences across the type of treatment service the youth received and the funding source for those treatment services. In general, outpatient treatment services were more likely to be funded by the court, while residential services (GMH, sex offender, and substance abuse) were more likely to be funded by external sources. These findings indicate that both characteristics of the youth and the type of treatment service required by the court are related to the source of funding used to pay for treatment services.

The results from a two-stage FIML probit model predicting external funding compared to court-based funding are presented in Table 5.⁸ The results from the analysis show that Native Americans are 76.5% (OR = 1.765) more likely to receive treatment services through external funding, which is likely due to their tribal health care. Youth who were living in state care, such as DCS, were over 2 times (OR = 2.07) more likely to receive treatment services through external funding sources. Youth who committed personal felonies and public peace offenses were 32.4% (OR = .676) and 46.3% (OR = .537), respectively, less likely to receive treatment services through external funding. Preadjudication detention and moderate-risk level had a positive significant effect, indicating that youth who were detained prior to adjudication and youth who were moderate-risk level are more likely to receive treatment services via external funding. In regard to psychological evaluation, youth who received a psychological evaluation were less likely to receive services through external funding.

Table 5.
Stage-Two FIML Probit Model Predicting External Funding for Treatment Services.^a

Variables b SE Exp(b)

Male 0.239 .161 —

Age −0.084 .069 —

Race/ethnicity

Black 0.076 .151 —

Latino(a) 0.141 .111 —

Native American 0.568* .264 1.765

Other 0.299 .438 —

Living situation

Two parents −0.285^† .171 —

Grandparents or relatives 0.121 .184 —

DCS and other 0.727 .265 2.069

Not enrolled in school 0.097 .121 —

Offense severity

Felony person −0.391 .148 0.676

Misdemeanor property 0.294 .181 —

Misdemeanor person −0.100 .193 —

Drugs −0.097 .159 —

Public peace −0.621 .230 0.537

Other −0.553 .532 —

Preadjudication detention 0.247 .105 1.280

Prior referral −0.054 .139 —

Prior adjudication −0.009 .204 —

Psychological evaluation −0.559*** .184 0.572

Prior treatment service 0.165 .145 —

Risk level

Moderate 0.442* .199 1.556

High 0.356 .238 —

Exclusive type of treatment service^b

GMH residential 0.929* .221 2.532

Sex offender outpatient −0.155 .199 —

Sex offender residential −0.293 .234 —

Substance abuse outpatient −0.251 .174 —

Substance abuse residential 1.235 .397 3.438

Other service −0.822* .325 0.440

Two services −0.599 .208 0.549

Three or more services −0.896 .342 0.408

Constant 1.648* .726 —

Log likelihood −1,983.15

Rho χ² 0.98

Model χ² 156.5***

Note. N = 861. GMH = general mental health; FIML = full information maximum likelihood; DCS = Department of Child Services; SE = standard error.

^aStage-one FIML probit model predicted youth receiving any treatment services.

^bMentoring/life skills services omitted due to perfect prediction into court-based funding.

p ≤ .05. p ≤ .01. p ≤ .001. ^†p ≤ .1.

Finally, to address the second part of the research question—certain treatment services were more likely to be funded by external sources, while other services were less likely, after controlling for individual covariates. Specifically, GMH and substance abuse residential services were more likely to be funded by external funding sources, whereas behavior-specific education, evidence-based, and drug court services were more likely to be funded by the court. Lastly, youth who received two services or three or more services were less likely to receive their services through external funding sources.

Discussion

The current study examined the receipt and funding of treatment services for mental and behavioral problems among a sample of youth under probation supervision. Over the last two decades, researchers and practitioners have started to examine mental and behavioral service needs of youth and gain a better understanding of the complexities of providing treatment services in the juvenile justice system. Given this context, the current study contributes to the larger body of research on juvenile justice and treatment services by (1) examining the actual receipt or use of treatment services by youth under probation supervision, rather than referrals for services, and (2) examining the source of funding for treatment services. In light of the significant findings presented in the previous section, there are a number of key findings: (1) Few youth overall receive treatment services while on probation, (2) there are racial disparities in the receipt of treatment services, and (3) a disconnect exists between receiving treatment services and the willingness or capability of external funding sources to fund these services. These findings deserve further elaboration in the broader context of research and implications for practice and policy.

Use of Treatment Services

The first main finding of the current study is that approximately 25% of youth on probation received treatment services. Estimates of mental health disorders among youth in the juvenile justice system are as high as 60–70% (Garland et al., 2001; Shufelt & Cocozza, 2006; Teplin et al., 2002), and roughly half of which also suffer from substance use disorders (Teplin et al., 2002). Given that almost 40% of the youth received a psychological evaluation (a proxy for mental health problems) in the current study, it was expected that more youth would receive treatment services. This finding is consistent with other research that has found a relatively small proportion of youth receive services in the juvenile justice system despite high prevalence rates (Rogers et al., 2006; Wasserman et al., 2008), providing additional support that youth with mental and behavioral problems are an underserved segment of the juvenile justice population.

Unlike much of the prior research, there were no gender differences in service use, but the living situation did influence the use of treatment services as well as a number of variables related to offending history and involvement in the juvenile justice system. Particularly youth who lived without their parents, either with grandparents or other family and especially those is DCS or State care, were more likely to receive services. Parents and caregivers play an important role in recognizing mental health problems and accessing services to meet service needs (Harrison, McKay, & Bannon, 2004); therefore, youth not living with parents and entering the juvenile justice system may have greater unmet service needs that were not being addressed previously. In comparison, youth living with parents may have more opportunity for support from parents, have fewer service needs, or may already be receiving services. Additionally, youth under the care of their grandparents or other relative may have been previously connected to social services agencies and professionals who may have facilitated services beyond those initiated by correctional service agencies. An alternative argument is that parents may pose certain obstacles to youth receiving services, such as lack of involvement (Broeking & Peterson-Badali, 2010; Davies & Davidson, 2001; Peterson-Badali & Broeking, 2010) or hesitation due to cultural or views about parenting, subsequently affecting youth’s responsivity to treatment (Haqanee et al., 2015). As a result, courts may be more likely to refer youth to services when they live with grandparents, other family, or some other care.

Youth convicted of a personal felony and high risk youth were also more likely to receive treatment services, while youth who were detained or had prior adjudication were less likely to receive services. In some ways, these are conflicting results; on one hand, it reflects that youth with more need (not living with parents, felony, and high risk) are getting services, but those previously detained or adjudicated are not as likely to receive services. This finding may reflect the court focusing services on youth with high need and limited involvement in the juvenile justice system, while the court may be more apprehensive to provide treatment services to repeat offenders because it is viewed as not effective or a good use of resources.

Importantly, a psychological evaluation was a strong predictor of receiving treatment, but there were still many youth who had an evaluation but did not receive services. Returning to the RNR model and the importance of identifying risk and needs, and matching services to those needs, this finding is consistent with research that has found identified needs are not always met with the appropriate services, often due to lack of resources and programming (Gebo, Stracuzzi, & Hurst, 2006; Shook & Sarri, 2007), experience with RNR assessments (C. Schwalbe, 2004), or prioritizing other needs that may not qualify as a risk/need according to assessment tools (Bonta, Rugge, Scott, Bourgon, & Yessine, 2008; Haqanee et al., 2015; Young, Moline, Farrell, & Bierie, 2006). In the current study, a small percentage (6.6% of youth receiving services) received evidence-based programs, which is a fraction of all the youth on probation, despite a large number of youth classified as high risk, suggesting a disconnect between risk/needs and use of evidence-based programming.

While support for RNR assessment tools and success in reducing risk of recidivism is evident, the complexities of youths’ risks and needs create many challenges for implementation in the justice system, particularly given the inconsistent relationship between mental health and recidivism (Bonta, Blais, & Wilson, 2014; Wibbelink et al., 2017). If treating mental health problems does not reduce recidivism, the juvenile justice system may not prioritize it as a need worth addressing. On the other side, mental health problems are considered in the responsivity principle and problems that interfere with or limit engagement in criminogenic need-focused intervention are prioritized for service. For instance, mental health problems may increase an individual’s vulnerability to criminogenic needs, such as when a mental health issue interferes with school performance or behavior or when mental health issues contribute to family conflict. More research is needed to untangle some of these nuances and complexities to provide clearer goals for the justice system in treating mental health problems. The current study did not have diagnostic information from youths’ case files, and as a result, the type of emotional or behavioral problem, the severity of the problem, history of substance abuse, and comorbidity with other disorders could not be determined, making it difficult to truly assess the level of service needs of these youth and whether the services are addressing those need.

Another key finding in the current study is the presence of racial and ethnic disparities in the receipt of treatment services by youth while on probation. Prior research has found that minorities are more likely to have unmet service needs compared to White youth (Alegria, Carson, Goncalves, & Keefe, 2011; Angold et al., 2002; Garland et al., 2005; Kataoka et al., 2002; Thompson, 2005; Yeh et al., 2003), and when they do receive treatment services, it is more likely to occur in the juvenile justice system rather than the mental health system (Atkins et al., 1999; Cohen et al., 1990; Dembo et al., 1994; Evens & Stoep, 1997; Thomas & Stubbe, 1996). The current study found that among youth on probation, Blacks and Latinos were less likely to receive treatment services than their White counterparts, after controlling for other youth and behavioral characteristics. Therefore, even though the juvenile justice system may be their best opportunity to receive treatment services (Rawal et al., 2004), minorities remain less likely to receive treatment services while under probation supervision.

This finding can be understood in the larger context of health disparities and access to health care. It is well-established that minorities, particularly Blacks, have poorer health which can be attributed to a number of factors such as low-socioeconomic status and limited access to quality health care (Center for Disease Control and Prevention, 2013). Additionally, racial and ethnic minorities have limited access to services, needs are more likely to go unmet, and when services are received they are of poor quality (Atdjian & Vega, 2005; McGuire & Miranda, 2008; Snowden, 2001; U.S. Department of Health and Human Services, 2001; Williams, 2005). These disparities have been attributed to limited access to treatment and health-care providers geographically and financially (Alegria et al., 2006; Simpson et al., 2005) as well as the mistrust of beneficial services and stigma associated with receiving mental health services inhibiting minorities in particular from seeking treatment services (U.S. Department of Health and Humans Services, 2001).

The disparate access to treatment services in the juvenile justice system may stem from multiple sources, including the identification and diagnosis of mental health and substance abuse disorders through common psychological evaluations and diagnostic instruments that have been criticized for their use on youth and minorities (Grisso, 2004). For example, diagnoses are not sensitive to contextual differences because disorders are identified based on the presence or absence of symptoms but fail to take into account the developmental relevance to youth or cultural differences (Grisso, 2004; Rogler, 1993; Safran et al., 2009; Smith, Spillane, & Annus, 2006; Wakefield, 1997). As a result, the service needs of minority youth may not be adequately identified and assessed.

Second, disparities may be the result of stereotyping and biased beliefs about amenability to treatment. Sentencing research has tested attribution theory (see Albonetti, 1991; Bridges & Steen, 1998) and has found that minorities are treated more harshly in the juvenile justice system because their behavior is attributed to internal causes or “bad” personality traits, rather than external factors that can be addressed with treatment. These negative stereotypes have also been found in the health field where doctors believe Blacks are less likely to comply with treatment (McGuire & Miranda, 2008). Similarly, court officials may believe that minority youth are less deserving of treatment services or that the treatment services will not be as effective or beneficial to minority youth. These findings support the historical argument that are two juvenile justice systems, one for Whites and one for Blacks (G. Ward, 2012), where minority youth have a different experience when they enter the juvenile justice system, characterized by harsh treatment and little access to services. This may have long-term implications for their involvement in the juvenile and criminal justice systems as well as perpetuating health differences that continue over the life course (Yazzie, 2011).

Youth with mental and behavioral service needs can be found in multiple “systems of care,” including the education system, the mental health system, child welfare system, and the juvenile justice system (Garland et al., 2001; Stroul, 2002; Stroul, Blau, & Sondheimer, 2008). It is essential that these systems of care collaborate by sharing information and resources to help ensure that service needs for youth who are vulnerable to mental and behavioral problems are identified as early as possible and that services are provided. Unmet mental and behavioral service needs in youth can affect both their success while on probation and their future involvement in the criminal justice system (Binswanger, Redmond, Steiner, & Hicks, 2012; Kutcher & McDougall, 2009; Yazzie, 2011) as well as other aspects of life like successful employment and healthy relationships.

Funding Sources of Treatment Services

The current research found that a majority (66%) of youth who received treatment services were funded by the court, and most of the youth who receive funding for treatment services through external funding sources, through AHCCCS or RBHA, as well as tribal health coverage. Very few youth received treatment services through private insurance, which was not unexpected because private insurance companies often have a disclaimer that the insurance company is not required to cover court-ordered services, unless medically necessary. Given the socioeconomic status of youth in the juvenile justice system, it was expected that more youth would have external funding for services through public assistance like AHCCCS. It may be that in some instances, the court is having to fund services of youth with private insurance who are not eligible for public assistance, but insurance will not cover the services. Unfortunately, the current study was not able to capture whether the youth had health coverage prior to their involvement in the juvenile justice system, or the type of health insurance, so it is difficult to assess the role of prior health coverage, and whether the court still funded the treatment services when a youth had coverage.

These findings are informative for court administrators to better understand the factors related to youth receiving treatment services through external funding compared to the youth who tend to receive services via court-based funding, which has implications for the continuity of care. Particularly, treatment services may be beneficial to youth after their involvement in the juvenile justice system, but without court-based funding, the services cannot be continued unless the youth is able to attain other sources to cover the cost of the services. If the youth is eligible for Medicaid to cover services, there may be a change in service provider and any established rapport with a mental health professional is disrupted. The process of continuing care after probation has ended may be less disruptive if the services are funded through external sources from the beginning. Youth may be able to continue using the same service provider with the same health care coverage. Youth who received psychological evaluations were more likely to have services funded by the court, which is likely because psychological evaluations are funded by the court so continuity of services is more likely if the same service provider and funding source is used by the court.

If more youth become insured and behavioral health services covered to a greater extent as a result of health-care reform (Cockburn, Heller, & Sayegh, 2013; Council of State Governments Justice Center, 2013), we may see more services in the juvenile and criminal justice system covered through external funding sources such as Medicaid or private insurance. Expanding mental health coverage and Medicaid may shift the burden of funding treatment services off the juvenile justice system and into the health-care system, allowing the juvenile justice system to focus on the delinquency of youth. This is consistent with Feld’s (1999) argument that the juvenile justice system should be responsible for responding to delinquent and criminal behavior and other systems of care should be responsible for the care and welfare of youth. This reform would require the collaboration of agencies to work together and share information regarding the service needs of youth to help them be successful while involved in the juvenile justice system and ensure treatment services are provided (Clark & Gehshan, 2006). There also needs to be clarity in the roles of different systems of care or agencies and implicit guidelines for responding to delinquency and youth experiencing emotional and behavioral problems.

Limitations

This study had the benefits of a large, representative sample of youth on probation, capturing the actual use of treatment service, and included a number of variables on prior delinquency and involvement in the juvenile justice system. But the study is not without its limitations. The sample is limited to one county in the Southwest, so it is not appropriate to generate findings to juvenile justice systems in other jurisdictions. In addition, the data are used for tracking youth and managing files, not for research purposes, so other measures particularly related to family/home and school/peer life that may impact service decisions were not captured. Perhaps most importantly, information from psychological evaluations such as mental health disorder diagnoses was not measured because information in the youth’s case file is typically not transferred into an electronic form. Without mental health diagnoses, it is difficult to directly measure service needs. In particular, the type and severity of emotional and behavioral disorders, as well as the comorbidity of disorders, has important implications for the receipt of treatment services.

Conclusion

There is growing recognition that youth suffer from mental and behavioral problems which affect multiple aspects of their lives and may put them at risk for delinquency and involvement in the juvenile justice system. Ideally, the juvenile justice system should be used as a last resort to address these adversities, but that is not typically the case. Instead, youth enter the juvenile justice system often due to the absence of viable, community-based alternatives to address the hardships in their lives (Myers & Farrell, 2008). The overlap in responsibilities for seriously delinquent youth and seriously mentally ill youth is often labeled as “not ours” (Grisso, 2004), demonstrating the difficultly of serving youth and the failure of different systems and agencies to take responsibility. The result can be a lifetime of involvement in the criminal justice system (Cocozza & Skowyra, 2000; Davis, Banks, Fisher, & Grudzinskas, 2004; Elliott, Huizinga, & Menard, 1989; Graves, Frabutt, & Shelton, 2007; Pullmann, 2010), which has been an ongoing struggle for the juvenile justice system and other systems of care (Grisso, 2004, 2008; Skowyra & Cocozza, 2007). Lipsey, Howell, Kelly, Chapman, and Carver (2010) argued that
the two most progressive policy reforms of recent years are the drive for evidence-based practice, which focuses on effective treatments, services, and supports for children and families, and the effort to establish systems of care to address the infrastructure of funding and linkages between services and programs. (p. 9)
Identifying service needs and providing services matched to those needs is not an easy process, but the consequences of ignoring the problems can have long-term negative effects both for the individual youth and for the larger community.

Variables	Youth on Probation (N = 3,779)
Outcome variables
Receiving treatment services	25.0	944
Funding source (n = 861)
Court-based	72.2	622
External	27.8	239
Independent variables
Gender
Female (reference)	18.8	712
Male	81.2	3,067
Race/ethnicity
White (reference)	37.4	1,414
Black	15.3	580
Latino	41.4	1,564
Native American	4.3	161
Other	1.6	60
Age (mean)	16.1 (1.3)	3,779
Living situation
Single parent (reference)	60.8	2,299
Two parents	19.6	741
Grandparents or other relatives	8.3	313
DCS and other	11.3	198
School status
Enrolled (reference)	75.1	2,839
Not enrolled	24.9	940
Offense severity
Property felony (reference)	25.1	948
Personal felony	19.1	720
Property misdemeanor	12.6	477
Personal misdemeanor	8.0	304
Drugs	18.8	710
Public peace	14.8	559
Other	1.6	61
Preadjudication detention	40.5	1,530
Prior referral	67.1	2,537
Prior adjudication	12.9	486
Psychological evaluation	37.5	1,416
Prior treatment services	18.3	692
Risk level
Low (reference)	20.4	770
Moderate	24.6	929
High	55.0	2,080

Variables	No Treatment Services	Treatment Services
Gender
Female (reference)	76.1	23.9
Male	74.8	25.2
Race/ethnicity*
White (reference)	73.2	26.8
Black	73.6	26.4
Latino	77.4	22.6
Native American	71.4	28.6
Other	80.0	20.0
Age (mean, SD)***	16.2 (0.02)	15.6 (0.04)
Living situation***
Single parent (reference)	78.2	21.8
Two parents	80.0	20.0
Grandparent or other family	69.3	30.7
Other-DCS	53.5	46.5
School enrollment^†
Enrolled in school (reference)	74.3	25.7
Not enrolled in school	77.2	22.8
Offense severity***
Property felony (reference)	78.0	22.0
Personal felony	59.7	40.3
Property misdemeanor	82.2	17.8
Personal misdemeanor	73.7	26.3
Drugs	78.7	21.3
Public peace	78.9	21.1
Other	82.0	18.0
Preadjudication detention***
Not detained (reference)	77.0	23.0
Detained	72.2	27.8
Prior referral
No prior referrals (reference)	74.1	25.9
Prior referral	74.5	24.5
Prior adjudication***
No prior adjudications (reference)	73.9	26.1
Prior adjudications	82.5	17.5
Psychological evaluation***
No psychological evaluation (reference)	87.9	12.1
Psychological evaluation	53.5	46.5
Prior treatment service**
No prior treatment services (reference)	75.8	24.2
Prior treatment services	71.5	28.5
Risk level***
Low (reference)	78.4	21.6
Moderate	77.3	22.7
High	72.7	27.3
N	2,835	944

Variables	b	SE	Exp(b)
Male	0.106	.109	—
Age	−0.226***	.033	0.797
Race/ethnicity
Black	−0.407**	.130	0.666
Latino(a)	−0.247**	.097	0.781
Native American	−0.088	.207	—
Other	−0.299	.367	—
Living situation
Two parents	0.029	.114	—
Grandparents or relatives	0.296*	.147	1.345
DCS and other	0.709***	.126	2.032
Not enrolled in school^†	−0.129	.105	—
Offense severity
Felony person	0.601***	.125	1.824
Misdemeanor property	−0.289	.162	—
Misdemeanor person	0.014	.172	—
Drugs	0.042	.137	—
Public peace	0.175	.145	—
Other	−0.116	.363	—
Preadjudication detention	−0.261**	.095	0.770
Prior referral	−0.121	.121	—
Prior adjudication	−0.494***	.144	0.610
Psychological evaluation	1.647***	.092	5.189
Prior treatment service	0.131	.111	—
Risk level
Moderate	0.035	.137	—
High	0.351*	.149	1.036
Constant	1.585**	.543	—
Log-likelihood	−1,754.29
Pseudo R ²	.1748

Variables	Court Based %	External %
Gender^†
Female	66.4	33.6
Male	73.5	26.5
Race/ethnicity***
White (reference)	76.3	23.7
Black	68.8	31.2
Latino	75.2	24.8
Native American	30.0	70.0
Other	54.5	45.5
Age—mean (SD)	15.7 (0.05)	15.3 (0.09)
Living with***
Two parents (reference)	80.8	19.2
Single parent	89.9	10.1
Grandparent or other family	74.7	25.3
Other-DCS	33.1	66.9
School enrollment
Enrolled in school (reference)	71.4	28.6
Not enrolled in school	74.9	25.1
Offense severity***
Property felony(reference)	73.0	27.0
Personal felony	70.9	29.1
Property misdemeanor	58.2	41.8
Personal misdemeanor	58.7	41.3
Drugs	78.1	21.9
Public peace	86.3	13.7
Other	80.0	20.0
Preadjudication detention**
Not detained (reference)	76.4	23.6
Detained	67.1	32.9
Prior referral^†
No prior referrals (reference)	76.2	23.8
Prior referral	70.2	29.8
Prior adjudication
No prior adjudications (reference)	72.3	27.7
Prior adjudications	71.4	28.6
Psychological evaluation**
No psychological evaluation (reference)	79.1	20.9
Psychological evaluation	69.0	31.0
Prior treatment service^†
No prior treatment services (reference)	73.6	26.4
Prior treatment services	67.2	32.8
Risk level***
Low (reference)	86.3	13.7
Moderate	68.2	31.8
High	69.6	30.4
Exclusive type of treatment service***
GMH outpatient (reference)	65.1	34.9
GMH residential	19.6	80.4
Sex offender outpatient	85.4	14.6
Sex offender residential	45.1	54.9
Substance abuse outpatient	85.3	14.7
Substance abuse residential	9.1	90.9
Other services	97.9	2.1
Two services	86.7	13.3
Three or more services	92.5	7.5

Variables	b	SE	Exp(b)
Male	0.239	.161	—
Age	−0.084	.069	—
Race/ethnicity
Black	0.076	.151	—
Latino(a)	0.141	.111	—
Native American	0.568*	.264	1.765
Other	0.299	.438	—
Living situation
Two parents	−0.285^†	.171	—
Grandparents or relatives	0.121	.184	—
DCS and other	0.727**	.265	2.069
Not enrolled in school	0.097	.121	—
Offense severity
Felony person	−0.391**	.148	0.676
Misdemeanor property	0.294	.181	—
Misdemeanor person	−0.100	.193	—
Drugs	−0.097	.159	—
Public peace	−0.621**	.230	0.537
Other	−0.553	.532	—
Preadjudication detention	0.247**	.105	1.280
Prior referral	−0.054	.139	—
Prior adjudication	−0.009	.204	—
Psychological evaluation	−0.559***	.184	0.572
Prior treatment service	0.165	.145	—
Risk level
Moderate	0.442*	.199	1.556
High	0.356	.238	—
Exclusive type of treatment service^b
GMH residential	0.929***	.221	2.532
Sex offender outpatient	−0.155	.199	—
Sex offender residential	−0.293	.234	—
Substance abuse outpatient	−0.251	.174	—
Substance abuse residential	1.235**	.397	3.438
Other service	−0.822*	.325	0.440
Two services	−0.599**	.208	0.549
Three or more services	−0.896**	.342	0.408
Constant	1.648*	.726	—
Log likelihood	−1,983.15
Rho χ²	0.98
Model χ²	156.5***

Footnotes

Appendix A

Youth Receiving Treatment Services.

Type of treatment service	All Youth Receiving Service		Youth Receiving Service Exclusively		Duration of Treatment Service^a (days)
Type of treatment service	n	%	n	%	Mean	SD	Median	Range
GMH outpatient	282	29.9	173	18.3	133.7	99.07	92.0	1–591
GMH residential	188	19.9	103	10.9	156.1	108.8	130.5	1–668
Sex offender outpatient	140	14.8	101	10.7	244.5	167.0	202.0	10–804
Sex offender residential	97	10.3	55	5.8	253.2	167.6	206.0	4–718
Substance abuse outpatient	196	20.8	95	10.1	134.8	93.1	90.0	4–633
Substance abuse residential	44	4.7	23	2.4	102.8	58.5	91.5	11–278
Mentoring and life skills	179	19.0	95	10.1	102.6	55.1	90.0	3–391
Behavior specific education	6	0.6	4	0.4	103.3	72.8	90.0	18–238
Evidence-based programs	62	6.6	31	3.3	141.9	80.4	131.0	4–430
Drug court	70	7.4	16	1.7	144.7	88.8	143.0	3–373
Two services	—	—	188	20.0	—	—	—	—
Three or more services	—	—	59	6.3	—	—	—	—
Total	—	—	944	100.0	186.4	141.1	147.0	1–850

Note. n = 944. Mode duration is 90 days for all types of services. GMH = general mental health; SD = standard deviation.

^aType of treatment services are not mutually exclusive.

Author’s Note

This study was approved by institutional review board. This article does not contain any studies with human or animal subjects. Data was de-identified and informed consent was not applicable.

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

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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