摘要：Objectives . We evaluated how improved mental health services affect justice involvement among juveniles treated in the public mental health system. Methods . Our analyses were based on administrative and interview data collected in 2 communities participating in the evaluation of a national initiative designed to improve mental health services for children and youths. Results . Results derived from Cox proportional hazard models suggested that better mental health services reduced the risks of initial and subsequent juvenile justice involvement by 31% and 28%, respectively. Effects were somewhat more pronounced for serious offenses. Conclusions . Our findings suggest that improved mental health services reduce the risk of juvenile justice involvement. Current research on youths treated in US public mental health systems reveals that many have been or will be involved in the juvenile justice system (E. M. Foster and T. Connor, unpublished data, 2002). 1, 2 Other research suggests that the obverse is also true: many youths in the juvenile justice system suffer from mental health problems. 3– 6 While these conditions may have been preexisting, entry into the juvenile justice system probably exacerbates them. Many observers fear that time spent in juvenile justice residential facilities further traumatizes these young people and only worsens their mental health problems. 7 Such findings suggest that keeping youths with emotional and behavioral problems out of the juvenile justice system should be a public heath priority. The overlap between the juvenile justice and mental health systems raises difficult questions surrounding service delivery to the children and youths straddling the 2 systems. One strategy for addressing these issues involves integration of and coordination between the mental health and juvenile justice systems. Such system-level coordination and collaboration is the focus of the so-called “system of care” approach to the delivery of mental health services, an approach that reflects a public health perspective on mental health problems. Under a system of care, responsibility for meeting the mental health needs of children and youths resides at the community level rather than with a single agency. Various child-serving agencies, such as mental health and juvenile justice, coordinate and integrate service delivery. Such collaboration can involve strategic planning, interagency budgeting and cost sharing, implementation of comprehensive screening and assessment, case management, and cross-training of staff. 8 When implemented, systems of care also involve changes in the types of mental health services delivered. These changes generally increase the use of community-based alternatives (e.g., day treatment or partial hospitalization) to restrictive inpatient hospitalization, and they can involve services, such as multisystemic therapy, 9– 17 targeted specifically to young people with a history of serious delinquency. Taken together, these elements of the system of care work to reduce juvenile justice involvement. As a result of system integration, youths with emotional and behavioral problems who break the law or engage in other offenses may have their problems identified more quickly and may be diverted into the mental health system. By targeting underlying mental health problems (such as aggression), mental health services may reduce the likelihood of a subsequent offense and contact with the juvenile justice system. At present, little research exists on how systems of care affect juvenile justice involvement. One possible basis for such research is the Comprehensive Community Mental Health Services for Children and Their Families Program (the “Children’s Program”) funded by the Substance Abuse and Mental Health Services Administration. This program is fostering public sector systems of care throughout the country. In several of the communities involved in the Children’s Program, juvenile justice is well integrated within the system of care. In Stark County (Canton), Ohio, for example, juvenile justice is integrated with the system of care at several levels: program administration, financing, service delivery, and training for juvenile justice personnel. Administratively, the system of care operates under the aegis of the Stark County Family Council, 18 whose board of trustees includes a juvenile justice official. The council administers pooled funds contributed by multiple child-serving agencies, including juvenile justice. At the level of service delivery, the target population for the system of care comprises youths who are at risk of out-of-home placement and who are involved in multiple child-serving sectors, including juvenile justice. Furthermore, there is a cross-system service planning process in which juvenile justice personnel can participate, and mental health staff are stationed at juvenile justice facilities. Finally, the mental health agency provides juvenile justice personnel with training in mental health issues (e.g., principles of multisystemic therapy). Stark County and 66 other communities are participating in an evaluation of the Children’s Program. This evaluation comprises both quantitative and qualitative elements; the former includes a longitudinal study of the children and youths served at each site. As a means of providing a group of comparison children and youths, 3 system-of-care sites were matched with comparison communities. One pair involves the Stark County system and a comparison site in Mahoning County (Youngstown), Ohio. Using data from these sites, we examined whether the system of care can eliminate or delay involvement in juvenile justice among youths receiving mental health services. Our analyses employed hazard models to examine the timing of first involvement with the juvenile justice system and the likelihood of recidivism. Analyses incorporated prestudy differences in demographic characteristics and risk of juvenile justice involvement.
