Research That Matters (January 17 - 20, 2008)

Purpose: Studies report that the rates of mental health disorders are nearly 70% among youth in the juvenile justice system (JJS), two to three times higher than among youth in the general population. While research (Koppelman, 2005; Skowyra, 2006) indicates that youth involved in JJS with mental health needs have not been consistently identified and effectively served, consumers and professionals' voices about their experiences with these issues are rarely heard. To gain an in-depth understanding of youth and family member's experiences on the process of securing mental health services for youth involved in JJS, this study examined the intricate operations of the two multi-layered service systems.

Method: Between March 2005 and May 2006, a total of 72 in-depth semi-structured interviews were conducted focusing on youth (n=18) and stakeholders (n=54) involved in their lives. The stakeholders included parents/guardians, and a mental health and a juvenile justice professionals from five different community mental health centers (CMHC) and judicial districts in Kansas. Transcripts from interviews were analyzed in two ways. First, qualitative analysis software ATLAS.ti was used by two coders for thematic analyses to identify themes across participants. Second, each case was summarized 1) to understand their experiences in a historical sense and 2) to illustrate the interaction of consumer characteristics with the service systems and various locations, ranging from rural to urban settings.

Results: Analyses yielded descriptive information regarding the degree of collaboration between the CMHC and JJ service systems which had a significant impact on the effectiveness of services and youth/family opinions about service success. First, a wide range of differences in collaboration within and across these systems were identified. The degree of collaboration differed by location. In areas where working relationships developed between individual professionals over time, there existed a higher level of collaboration. Conversely, in areas of high staff turnover, collaboration became more difficult or nonexistent. Second, while some effective collaboration occurred idiosyncratically or informally at the direct contact level, often collaboration was not driven by systemic properties. In general, a lack of formal local policies or procedures supporting collaborative efforts was observed across both systems. Even when a policy or committee did exist, difficulty in operationalizing policy at a direct contact level was indicated. Third, a breakdown of collaboration and services was found when the child was in crisis, especially during transitions to and from out-of-home placements. In addition, youth and parents gave strong voices to their experiences and needs. Each set of professionals suggested ideas about what changes need to occur to improve their partnerships.

Conclusions and Implications: This study provides an in-depth understanding regarding the nature of service delivery and collaboration for youth with mental health needs in JJ service systems. Findings exemplify the need for improved collaboration by considering institution of programs such as statewide CMHC and JJ agency policies; evidence-based treatment models; staff training programs; and sufficient funding. Such actions should improve outcomes for high-risk youth by maintaining them in their communities, reducing recidivism, and eliminating unnecessary human suffering.