Treatment Services in the Juvenile Justice System: Examining the Use and Funding of Services by Youth on Probation

• DOI: 10.1177/1541204017728997
• Author: Clair White
• Date: 01 January 2019
• Published date: 01 January 2019
• Subject Matter: Articles

Article
Youth Violence and Juvenile Justice
2019, Vol. 17(1) 62-87
Treatment Services in
ª The Author(s) 2017
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DOI: 10.1177/1541204017728997
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Examining the Use and
Funding of Services by
Youth on Probation
Clair White1
Abstract
Youth enter the juvenile justice system with a variety of service needs, particularly for mental
health problems. Research has examined the extent to which youth have mental health disorders,
primarily among detained youth, and factors associated with treatment referrals, but little
research has examined youth on probation and the actual use of services. Using data obtained
from the Maricopa County Juvenile Probation Department from July 2012 through August 2014
(N ¼ 3,779), the current study examines (1) the factors associated with receiving treatment
services while on probation and (2) the factors associated with receiving treatment services
through different funding streams. Findings reveal that only about 25% of the sample of youth on
probation received treatment services, suggesting the underservicing of youth. Consistent with
prior research, there were also racial and ethnic disparities concerning treatment use, with Blacks
and Latinos less likely to receive services. Additionally, certain characteristics of youth and their
background influenced the funding source for treatment services. Implications for policy and
research are discussed in light of these findings.
Keywords
probation, treatment services, service use, juvenile justice, racial/ethnic disparities
The juvenile justice system has multiple responsibilities often serving conflicting goals of punitive
sanctions and rehabilitative treatment (Bishop, 2006; Lipsey, Howell, Kelly, Chapman, & Carver,
2010). The system must not only address the current delinquent behavior but also, in many cases,
consider the health and well-being of the youth. Youth come into the juvenile justice system with
more complex problems and greater needs for mental and behavioral health services, which has
resulted in more attention on efforts to rehabilitate and address youth’s mental and behavioral
1 Center for Evidence-Based Crime Policy, Criminology, Law and Society, George Mason University, Fairfax, VA, USA
Corresponding Author:
Clair White, Center for Evidence-Based Crime Policy, Criminology, Law and Society, George Mason University, 4400
University Dr., MS 6D12, Fairfax, VA 22030, USA.
Email: cwhite28@gmu.edu

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White
63
service needs (Myers & Farrell, 2008). Research has examined a number of issues related to mental
health and behavioral health problems of youth in the juvenile justice system, particularly identify-
ing the rates of mental health problems and service needs among youth and factors associated with
treatment referrals of youth in different systems of care (i.e., juvenile justice system and mental
health system).
Research on mental health problems in justice-involved youth has primarily focused on the
service needs of youth and where they have been referred to meet these needs and not on whether
they actually received those services. Additionally, much of the work examines youth in detention or
compares youth sentenced to community versus correctional supervision rather than youth on
probation which is the predominate sentence in the juvenile justice system. The current study uses
juvenile probation data from a large, urban jurisdiction in Arizona to examine these issues. More
specifically, legal and extralegal factors associated with the use of treatment services among youth
on probation supervision are examined. Furthermore, the extent to which services are funded by the
juvenile justice system has not been empirically examined, therefore, whether these services are
funded by the juvenile justice system or external funding sources such as Medicaid or private
insurance is also examined.
Unmet Service Needs and Treatment Referrals
Youth involved in the juvenile justice system often experience multiple adversities or risk factors,
such as economic disadvantage, experiences of abuse and neglect, unstable family environments,
exposure to drugs and alcohol, and mental illness (Esbensen, Peterson, & Taylor, 2010; Huizinga,
Loeber, Thornberry, & Cothern, 2000; Loeber & Farrington, 1998). Research has generally found
that 65–70% of youth in juvenile justice facilities, primarily detention centers and correctional
facilities, suffer from at least one mental health disorder (Shufelt & Cocozza, 2006; Teplin, Abram,
McClelland, Dulcan, & Mericle, 2002; Wasserman, McReynolds, Lucas, Fisher, & Santos, 2002),
while rates among youth on probation are approximately 50% (Wasserman, McReynolds, Ko, Katz,
& Carpenter, 2005).
Additionally, comorbidity, or the presence of more than one mental or behavioral disorder, is
particularly high among youth in juvenile justice settings (Abram, Teplin, McClelland, & Dulcan,
2003; Kessler et al., 1996; Teplin et al., 2002). Shufelt and Cocozza (2006) found that roughly 79%
of those who met criteria for at least one mental health disorder had two or more diagnoses.
Unfortunately, many of these mental and behavioral service needs are not met in the community
(Flisher et al., 1997; Jensen et al., 2011; Kataoka, Zhang, & Wells, 2002; Ringel & Sturm, 2001). As
a result, the coexistence of multiple disorders in addition to other criminogenic risk factors makes
prioritizing mental and behavioral service needs more challenging for the juvenile justice system
(Grisso, 2004).
Research has examined factors related to unmet service needs and the avenues through which
youths’ mental health needs are met through various service sectors, such as the mental health
system and juvenile justice system (Burns et al., 2004; Stahmer et al., 2005; Thompson, 2005).
Among the general population, children and adolescents with mental and behavioral health problems
are gravely undertreated with high rates of unmet service needs (Angold et al., 1998; Flisher et al.,
1997; Horwitz, Gary, Briggs-Gowan, & Carter, 2003). Studies have examined characteristics of
children with unmet mental health needs and their families using various samples to identify key
predictors of treatment service use and unmet service needs.
Among the primary factors associated with unmet service needs are elements related to economic
disadvantage such as living on public assistance, lack of health insurance, and transportation prob-
lems (Chow, Jaffee, & Snowden, 2003; Cornelius, Pringle, Jernigan, Kirisci, & Clark, 2001; Haines,
McMunn, Nazroo, & Kelly, 2002). Race and ethnicity are also strong predictors of unmet service

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Youth Violence and Juvenile Justice 17(1)
needs with Whites being more likely to receive mental health services compared to minorities
(Angold et al., 2002; Garland et al., 2005; Kataoka et al., 2002; Thompson, 2005; Yeh, McCabe,
Hough, Dupuis, & Hazen, 2003). Studies have also found that minorities have limited opportunities
to access mental health services (Arcia, Keyes, Gallagher, & Herrick, 1993), and once they start
treatment they are less likely to complete treatment (Kazdin, Stolar, & Marciano, 1995).
Research has also found involvement in the mental health system increases the likelihood of
being referred to the juvenile justice system (Cohen et al., 1990; Evens & Stoep, 1997; Rosenblatt,
Rosenblatt, & Biggs, 2000). In addition, younger adolescents, females, and White youths are more
likely to be referred to the mental health system, while minorities, males, and youths with more
serious and disruptive mental health disorders are more likely to be referred to the juvenile justice
system (Atkins et al., 1999; Cohen et al., 1990; Dembo, Turner, Borden, & Schmeidler, 1994; Evens
& Stoep, 1997). In general, service needs of disadvantaged and minority youth are often not
recognized until their contact with the juvenile justice system (Golzari, Hunt, & Anoshiravani,
2006; Rawal, Romansky, Jenuwine, & Lyons, 2004; Rogers, Pumariega, Atkins, & Cuffe, 2006).
Upon entering the juvenile justice system, service needs often continue to go unmet even after
identification of need for treatment (Rogers, Zima, Powell, & Pumariega, 2001; Shelton, 2005).
Shelton (2005) found that only 23% of youth diagnosed with mental health disorders received
treatment and that having a mental disorder was not a significant predictor of receiving services.
A recent study conducted by Hoeve, McReynolds, and Wasserman (2014) found that youth with
externalizing disorders and substance use disorders were more likely to receive referrals, while only
40% of youth with internalizing disorders referred to service. Consistent with the findings from the
general public, Whites are more likely to be referred to services compared to Black youth in the
justice system (Dalton, Evans, Cruise, Feinstein, & Kendrick, 2009; Lopez-Williams, Stoep, Kuro,
& Stewart, 2006; Maschi, Hatcher, Schwalbe, & Rosato, 2008; Rogers et al., 2006), but there are
some mixed findings (Breda, 2003; Hoeve et al., 2014). Shelton (2005) concluded that
while the total responsibility for the well-being of children does not lie solely with the juvenile justice
system, the decision not to provide treatment services to youth in need and under their care implies
neglect . . . it implies a perception that these youth will go away, be treated elsewhere, or grow out of their
problems. (p. 110)
These prior studies do not provide a clear set of predictors for service referrals and many studies
were not...