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Identifying Mental Health Treatment Needs Among Serious Institutionalized Delinquents Using Paper-and Pencil Screening Instruments, Final Report

NCJ Number
Date Published
62 pages
This report examines the usefulness of the California Youth Authority’s (CYA) current mental health and substance abuse screening process, or the Treatment Needs Assessment (TNA), for identifying wards for whom mental health intervention is needed and for profiling the aggregate mental health treatment needs of incoming wards.
Commitment to the CYA is limited to juveniles who commit serious crimes, who have extensive criminal histories, and/or who have failed at local interventions. All youth entering the CYA are evaluated through an assessment process known as the TNA. At present, the TNA is used only as a screening tool and is not part of the formal identification and evaluation process. The screening process uses a self-report assessment battery, which includes: Achenbach Child Behavior Checklist – Youth Self Report (YSR); Massachusetts Youth Screening Instrument, Second Version (MAYSI); Weinberger Adjustment Inventory (WAI); and Drug Experience Questionnaire (DEQ). This study focused on the ability of the instruments in the TNA to identify juveniles whose mental health problems rose to the level that services were considered appropriate during their 12 to 18 month stay at the CYA. Data were collected from 795 males entering the CYA from October 1998 through February 1999 and from 183 females entering the CYA from October 1997 to June 1999. The time frame for females was longer than for males in order to obtain a sample large enough for statistical analysis. Follow-up data focused on whether or not youths in the sample: 1): were provided mental health treatment while in CYA institutions; 2) were prescribed medications used to treat serious mental health problems; or 3) were identified as needing treatment by CYA treatment or clinical staff but treatment was not yet provided. Analysis focused on the association between elevations on scales within the screening battery and these indicators of mental health service need. The WAI, which does not focus specifically on mental health problems, was not included in these analyses. Results of the analysis found that 38.2 percent of the research sample had at least one indicator of mental heath intervention or identification, about18 percent of the sample had been placed at least once before in a mental health program, and 21 percent one or more prescriptions for medications typically used to treat serious psychological problems. For both samples combined, 29.5 percent were either placed in a mental health program or were prescribed psychotropic medications. Another 8.6 percent were identified as having mental health problems on the basis of psychological evaluations, suicide referrals, or verified staff observations. For those youth with any of these mental health problem indicators, over half (56.7 percent) had more than one indicator. When broken down for males and females the percentages were markedly different. Nearly 46 percent of the females were placed at least once in a mental health program (compared to 11 percent of the males), and 42 percent of the females were prescribed psychotropic medications (compared to 16 percent of the males). In all, over two-thirds of the female youth in the sample had at least one indicator of mental health intervention, compared to 31 percent of the males. These gender differences may be due, in part, to the greater availability of services for female wards, but that availability is due to a greater perceived need for these services for females. Analysis found that the MAYSI scales and the YSR scales were related to validation criteria in expected ways. Youth with elevated scores on these instruments were more likely to come to the attention of mental health personnel. Of the two instruments, MAYSI performed better, with elevations on the MAYSI scales being better predictors of later mental health intervention than were elevations on similar YSR scales. Over 70 percent of the youths had DEQ scores indicating substance abuse problems. This information, however, did not aid in predicting mental health intervention. Prior criminal behavior also did not improve predictions. These results indicate that both the MAYSI and the YSR appeared to provide results that could aid in identifying male wards that would later require mental health services while incarcerated. Neither instrument was particularly helpful for predicting intervention for female wards. Further, both the MAYSI and the YSR appeared to understate the extent of mental health problems for females. An important next step will be to examine the performance of these instruments in terms of their ability to identify CYA wards with acute mental health problems, rather than in terms of referral for treatment. References, 10 tables, and 2 appendices

Date Published: January 1, 2003