Outcomes Following Intensive in Home Services for Youth with Juvenile Court Involvement

Background and Purpose:  Youth with juvenile court involvement are at elevated risk of problematic outcomes, including conduct problems, out of home placement, and criminal behavior in adulthood. In-home services have shown promise for improving outcomes for system-involved youth (Barth, Greeson, Guo, Green, Hurley & Sisson, 2007; Bright, Hurley, & Barth, 2014) but it is largely unknown whether these services are effective with different subgroups of youth involved with various child-serving systems. The purpose of the current study is to investigate outcomes from an agency-developed intensive in-home family centered service, exploring whether youth with juvenile justice involvement compared to youth who do not have such involvement fare better in treatment. The intensive in-home services model includes family therapy, mental health treatment for caregivers, parenting skills education and help in accessing community resources, with the goal of assisting caregivers to create a support system that will be functional long after services end. We explore whether juvenile justice system involvement predicts treatment outcomes on the youth version of the Strengths and Difficulties Questionnaire (SDQ; Goodman, 1997), controlling for behavioral and demographic characteristics (n=2420).

Method: This study used data from a large behavioral health organization that serves youth with severe emotional and/or behavioral issues. Nearly all youth have a previous history in the juvenile court, child welfare, and/or mental health system; many have experience with multiple systems.  Youth were between age 11 and 17 years old and received in-home services between 2007 and 2011.  Youth were characterized as juvenile court-involved at intake and compared to those who did not have previous court involvement. Data were gathered at intake and again at discharge with the SDQ as the primary outcome of interest. Following bivariate exploration, within-subject change over time and between-subject factors of treatment, juvenile court involvement, and behavioral and demographic characteristics were explored using a generalized estimating equation (GEE) model.

Results: Results from the GEE model indicate juvenile court involved youth (B=1.33, SE=.24, χ²=30.31) were more symptomatic at discharge compared with youth who were not court-involved. Additionally, youth who identified as African American (B=1.70, SE=.26, χ2=43.59), Hispanic, Asian, Native American, or Bi-racial (B=.88, SE=.39, χ2=4.98), were more symptomatic at discharge compared with youth who were Caucasian. Conversely, girls (B=-1.52, SE=.23, χ²=43.23) compared with boys, and youth with impulsive (B=-1.88, SE=.23, χ²=65.00), and aggressive (B=-1.78, SE=.34, χ²=27.35) behaviors fared better in treatment.

Conclusions and Implications:  Findings suggest the agency-developed intensive in home treatment approach was most effective for girls (χ²=43.23) or youth with impulsive (χ²=65.00) behaviors. SDQ total difficulties scores indicate youth were in the moderate difficulty range at intake and discharge suggesting the service was similarly effective for court-involved and non-court involved youth. Given that youth exhibited improvements in behavioral health symptoms and in developing positive social and emotional skills, this study indicates that broader application of these services may have a positive impact for children and families regardless of juvenile court involvement.