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Research ArticleRegular Article

Mental Health Service Referral and Treatment Following Screening and Assessment in Juvenile Detention

Frank Tedeschi, Sarah McCue Horwitz, Michael Surko, Emily Weinberger, Amanda Bart, Carly Baetz, Fei Guo, Ava Alexander and Jennifer F. Havens
Journal of the American Academy of Psychiatry and the Law Online October 2024, JAAPL.240082-24; DOI: https://doi.org/10.29158/JAAPL.240082-24
Frank Tedeschi
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
MD
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Sarah McCue Horwitz
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
PhD
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Michael Surko
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
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Emily Weinberger
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
PhD
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Amanda Bart
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
MA
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Carly Baetz
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
JD, PhD
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Fei Guo
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
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Ava Alexander
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
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Jennifer F. Havens
Dr. Tedeschi, Dr. Surko, and Dr. Baetz are Clinical Assistant Professors; Dr. Horwitz is a Professor; Mr. Guo is a research scientist; and Dr. Havens is Department Chair, Department of Child & Adolescent Psychiatry (DCAP), New York University Grossman School of Medicine, New York, New York. Dr. Weinberger is a psychology resident, Denver Health Medical Center, Denver, Colorado. Ms. Bart is an executive assistant, Brennan Center for Justice at NYU School of Law, New York, New York. Ms. Alexander is a doctoral student, Department of Psychology, University of Utah, Salt Lake City, Utah.
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Article Figures & Data

Tables

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    Table 1

    Sociodemographics of Youth Screened

    Total Youth ScreenedaYouth Not EvaluatedYouth Evaluatedb
    n(%)cn(%)cn(%)cp
    Total581—272—309——
    Sex——————0.370d
     Female131(22.5)57(21.0)74(23.9)—
     Male449(77.3)214(78.7)235(76.1)—
     Trans/female1(0.2)1(0.4)0(0.0)—
    Age——————0.871e
     12–14229(39.8)108(40.3)121(39.3)—
     15+347(60.2)160(59.7)187(60.7)—
     Missing5—4—1——
    Race or ethnicity——————0.368d
     Black365(63.5)180(66.7)185(60.7)—
     Hispanic178(31.0)73(27.0)105(34.4)—
     White18(3.1)9(3.3)9(3.0)—
     Asian or Pacific Islander11(1.9)6(2.2)5(1.6)—
     Other3(0.5)2(0.7)1(0.3)—
     Missing6—2—4——
    Detainee status——————0.227e
     JD481(83.5)224(83.6)257(83.4)—
     JO80(13.9)34(12.7)46(14.9)—
     Other15(2.6)10(3.7)5(1.6)—
     Missing5—4—1——
    Screening results———————
     PTSD67(11.5)15(5.5)52(16.9)<0.001e
     Depression——————<0.001e
      Absent or mild513(88.3)255(93.8)258(83.5)—
      Moderate51(8.8)14(5.1)37(12.0)—
      Severe17(2.9)3(1.1)14(4.5)—
     Problematic substance use273(47.0)108(39.7)165(53.4)0.001e
    • JD = juvenile delinquent; JO = juvenile offender; PTSD = posttraumatic stress disorder.

    • ↵a Refers to youth who received an initial screening after admission to the detention facility.

    • ↵b Refers to youth who received a diagnostic evaluation after the initial screening.

    • ↵c Refers to column percentages within the category.

    • ↵d Fisher’s exact tests were performed.

    • ↵e Chi-squared tests were performed.

    • View popup
    Table 2

    Sociodemographics of Youth Evaluateda

    TotalReferred for Evaluation Because of Elevated Score (+SCREEN)Referred for Evaluation for Other Reasons (+MH or BEH)Placement Evaluation Only (PLACE)
    n(%)bn(%)bn(%)bn(%)bp
    Total309—59(19.1)186(60.2)64(20.7)—
    Sex————————0.103c
     Female74(23.9)17(28.8)48(25.8)9(14.1)—
     Male235(76.1)42(71.2)138(74.2)55(85.9)—
    Age————————0.500c
     12-14121(39.3)21(35.6)78(41.9)22(34.9)—
     15+187(60.7)38(64.4)108(58.1)41(65.1)—
     Missing1—0—0—1——
    Race or ethnicity————————0.817d
     Black185(60.7)33(56.9)107(58.5)45(70.3)—
     Hispanic105(34.4)23(39.7)65(35.5)17(26.6)—
     White9(3.0)2(3.4)6(3.3)1(1.6)—
     Asian or Pacific Is5(1.6)0(0.0)4(2.2)1(1.6)—
     Other1(0.3)0(0.0)1(0.5)0(0.0)—
     Missing4—1—3—0——
    Detainee status————————0.002d
     JD257(83.4)43(72.9)154(82.8)60(95.2)—
     JO46(14.9)16(27.1)28(15.1)2(3.2)—
     Other5(1.6)0(0.0)4(2.2)1(1.6)—
     Missing1—0—0—1——
    Screening Results
     PTSD52(16.8)43(72.9)7(3.8)2(3.1)<0.001c
     Depression————————<0.001c
      Absent or mild258(83.5)24(40.7)171(91.9)63(98.4)—
      Moderate37(12)21(35.6)15(8.1)1(1.6)—
      Severe14(4.5)14(23.7)0(0.0)0(0.0)—
     Problematic substance use165(53.4)36(61)99(53.2)30(46.9)0.290c
    Diagnosis
     Disruptive behavior230(74.4)38(64.4)140(75.3)52(81.2)0.093c
     Substance related169(54.7)29(49.2)102(54.8)38(59.4)0.522c
     Neurodevelopmental158(51.1)28(47.5)115(61.8)15(23.4)<0.001c
     Trauma related139(45.0)45(76.3)63(33.9)31(48.4)<0.001c
     Depressive43(13.9)16(27.1)23(12.4)4(6.2)0.002c
     Anxiety7(2.3)3(5.1)2(1.1)2(3.1)0.090d
     Psychotic5(1.6)1(1.7)4(2.2)0(0.0)0.689d
     Bipolar3(1.0)0(0.0)3(1.6)0(0.0)0.774b
     Sleep-wake1(0.3)0(0.0)1(0.5)0(0.0)1.000b
     Obsessive-compulsive1(0.3)0(0.0)1(0.5)0(0.0)1.000b
     Other conditions60(19.4)5(8.5)30(16.1)25(39.1)<0.001c
     Insufficient data141(45.6)20(33.9)86(46.2)35(54.7)0.067c
     Non-DSM-5 diagnoses23(7.4)6(10.2)10(5.4)7(10.9)0.200d
     Medical diagnosis1(0.3)0(0.0)1(0.5)0(0.0)1.000d
    Treatment modality
     Med management only18(5.8)2(3.4)16(8.6)0(0.0)0.256d,e
     Therapy only16(5.2)4(6.8)12(6.5)0(0.0)1.000d,e
     Med management + therapy112(36.2)28(47.5)84(45.2)0(0.0)0.874c,e
    Medication type
     Psychostimulant76(24.6)15(25.4)61(32.8)0(0.0)0.365c,e
     Sleep aid46(14.9)12(20.3)34(18.3)0(0.0)0.872c,e
     Alpha-2 agonist38(12.3)7(11.9)31(16.7)0(0.0)0.496c,e
     Antipsychotic29(9.4)3(5.1)26(14.0)0(0.0)0.107c,e
     Antidepressant19(6.1)9(15.3)10(5.4)0(0.0)0.028c,e
     Mood stabilizer7(2.3)1(1.7)6(3.2)0(0.0)1.000d,e
     Other10(3.2)2(3.4)8(4.3)0(0.0)1.000d,e
    Classes of medications————————0.285d,e
     0171(55.3)30(50.8)77(41.4)64(100)—
     173(23.6)15(25.4)58(31.2)0(0.0)—
     251(16.5)9(15.3)42(22.6)0(0.0)—
     38(2.6)4(6.8)4(2.2)0(0.0)—
     44(1.3)1(1.7)3(1.6)0(0.0)—
     52(0.6)0(0.0)2(1.1)0(0.0)—
    Number of medications————————0.543d,e
     0171(55.3)30(50.8)77(41.4)64(100)—
     169(22.3)12(20.3)57(30.6)0(0.0)—
     250(16.2)11(18.6)39(21)0(0.0)—
     311(3.6)4(6.8)7(3.8)0(0.0)—
     44(1.3)1(1.7)3(1.6)0(0.0)—
     53(1)1(1.7)2(1.1)0(0.0)—
     61(0.3)——1(0.5)0(0.0)—
    Number of counseling sessions————————<0.001c
     084(27.2)10(16.9)41(22.0)33(51.6)—
     1-5123(39.8)26(44.1)74(39.8)23(35.9)—
     6-1035(11.3)6(10.2)28(15.1)1(1.6)—
     11-2039(12.6)10(16.9)26(14.0)3(4.7)—
     21+28(9.1)7(11.9)17(9.1)4(6.2)—
    • DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; JD = juvenile delinquent; JO = juvenile offender; PTSD = posttraumatic stress disorder.

    • ↵a Refers to youth who received a diagnostic evaluation following the initial screening.

    • ↵b Refers to column percentages within the category.

    • ↵c Chi-squared tests were performed for the other variables.

    • ↵d Fisher’s exact tests were performed for these variables.

    • ↵e The contrast was only between youth referred for evaluation because of elevated score and youth referred for evaluation because of other reasons.

    • View popup
    Table 3

    Diagnosis among Evaluated Youth by Type of Treatment

    Type of Treatment Provided
    Total EvaluatedNo Med Management or TherapyMed Management + TherapyMed Management OnlyTherapy Only
    3091631121816p
    Diagnosisnn (%)an (%)an (%)an (%)a—
     Trauma related13981 (58.3)44 (31.7)7 (5.0)7 (5.0)0.360b
     Substance related16992 (54.4)58 (34.3)12 (7.1)7 (4.1)0.494b
     Neurodevelopmental15860 (38.0)80 (50.6)11 (7.0)7 (4.4)<0.001b
     ADHDc15153 (35.1)80 (53.0)11 (7.3)7 (4.6)<0.001b
     Disruptive behavior230124 (53.9)82 (35.7)16 (7.0)8 (3.5)0.076d
     Depressive4320 (46.5)16 (37.2)5 (11.6)2 (4.7)0.358d
    • ADHD = attention-deficit/hyperactivity disorder.

    • ↵a The percentage of evaluated youth within each diagnosis category who received each type of treatment.

    • ↵b Chi-squared tests were performed for these variables.

    • ↵c ADHD is presented as a subset within the neurodevelopmental category because of its high prevalence.

    • ↵d Fisher’s exact tests were performed for these variables.

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Journal of the American Academy of Psychiatry and the Law Online: 53 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 53, Issue 1
1 Mar 2025
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Mental Health Service Referral and Treatment Following Screening and Assessment in Juvenile Detention
Frank Tedeschi, Sarah McCue Horwitz, Michael Surko, Emily Weinberger, Amanda Bart, Carly Baetz, Fei Guo, Ava Alexander, Jennifer F. Havens
Journal of the American Academy of Psychiatry and the Law Online Oct 2024, JAAPL.240082-24; DOI: 10.29158/JAAPL.240082-24

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Mental Health Service Referral and Treatment Following Screening and Assessment in Juvenile Detention
Frank Tedeschi, Sarah McCue Horwitz, Michael Surko, Emily Weinberger, Amanda Bart, Carly Baetz, Fei Guo, Ava Alexander, Jennifer F. Havens
Journal of the American Academy of Psychiatry and the Law Online Oct 2024, JAAPL.240082-24; DOI: 10.29158/JAAPL.240082-24
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