A Systematic Review of Interventions to Improve Outcomes of Crossover Youth

Background and Purpose: Services providers and researchers have acknowledged the needs of a group of youth who overlap both child welfare and juvenile justice systems, referred to as crossover youth. Crossover youth cost public services more than double that of youth in a single system. They also experience higher rates of incarceration, homelessness, substance abuse, unemployment, and high-risk health and sexual behaviors in adulthood. Although systematic reviews have been published examining interventions for youth in either the child welfare or juvenile justice system, there has not been a review examining the effectiveness of interventions for crossover youth. This review addressed the knowledge gap through the following research questions: 1) What were the types of interventions delivered to crossover youth? 2) What were the most common outcomes reported across studies? 3) What were the methodological strengths and weaknesses of studies? 4) What types of interventions were most effective (institution-based vs. community-based; brief vs. extended) when considering the rigor of the methods?

Methods: A systematic search of 21 databases was conducted to identify empirical articles in peer-reviewed journals published between 2000 and 2020. Studies were included for review if the sample included youth ages 10-21 years old who had involved with the child welfare and juvenile justice systems in the United States. Study methodological rigor was assessed using an adapted version of the Methodological Quality Rating Scale (MQRS) consisting of 12 items and a possible range of 0-14 (Auslander et al., 2012), to distinguish between low and high levels of rigor and areas of strengths and weaknesses. Level of rigor was combined with statistical significance to assess the strength of the evidence by using outcome attainment index (1=non-significant results, high and low rigor; 2=significant results, low rigor; 3=significant results, high rigor). Scores were used to compare the evidence of interventions by type (institution-based vs. community-based) and duration (brief vs. extended).

Results: Fourteen studies met the inclusion criteria for this review. Seven interventions were institution-based; 7 were community-based. Six interventions were brief; 8 were extended. The most common outcome evaluated was recidivism (n=11), followed by safe sex awareness (n=3) and social support (n=3). Study rigor was high (median=8) on a 14-point scale. Areas of strengths were theoretical foundation, objective verification, and statistical analyses. Weakness included a lack of reporting dropout and multi-site designs. Community-based interventions were more effective than institution-based interventions at reducing recidivism, with 67% of high rigor studies finding significant positive effects compared to 20% of institution-based interventions. Extended interventions were more effective than brief interventions to reduce recidivism, with 50% of high rigor studies showing significant results compared to 33% of brief interventions.

Conclusions and Implications: This review found that community-based and extended interventions have provided the strongest evidence for reducing recidivism of crossover youth. Results suggest a need for a gold standard outcome used across all studies. Because crossover youth face multiple challenges transitioning to adulthood in addition to recidivism, future studies need to evaluate other behavioral life outcomes of crossover youth consistently.