From Mental Health to Juvenile Justice: What Factors Predict This Transition?

We identify youth who are at risk for a critical transition from mental health to juvenile justice. A statewide longitudinal sample of Medicaid-eligible youth (aged 10–17) in the public mental health system (n = 5,455), during approximately one fiscal year (July 1, 1994–August 30, 1995), was used to determine the risk factors for, and timing of, a subsequent juvenile justice detention or commitment during the three subsequent fiscal years (1994–1997). Logistic regression and Cox Proportional Hazards modeling were used. Risk factors for juvenile justice detention or commitment included being: male, black or Hispanic, in junior high school, involuntarily admitted to mental health, having a DSM-IV diagnosis of conduct disorder, alcohol problems, a constellation of risk behavior, and receiving prior mental health services. Factors that accelerate the timing of detention or commitment in the juvenile justice system after a mental health visit included most of the general risk factors except risk behavior and involuntary admission were no longer significant and having a DSM-IV nonalcohol drug use diagnosis, antisocial behavior, and school problems became significant. Our study helps to identify youth who are at risk for multiple system use so that they may be provided appropriate services to prevent multiple system use.     

An effective approach to violence prevention: traditional martial arts in middle school

This study replicated and extended the design and outcome measures of several small studies. In these studies, juveniles at high risk for violence and delinquency showed decreased violence and positive changes in psychological risk factors after being required to take a school-linked course in traditional martial arts. In the present study, 60 boys in a large urban middle school were required to take a traditional martial arts course in their school. They were paired on problematic behavior profiles and assigned to a treatment group or to a wait-list control group. Thirty classes, three per week (45 minutes each), were taught by a master of Koga Ha Kosho Shorei Ryu Kempo and his assistant (neither was a public school teacher). Results are reported here for 14 variables from the following measures: four teacher rating scales from the Sutter-Eyberg Student Behavior Inventory, five self-report scales of the Piers-Harris Self-Concept Scale, four computerized measures of attentional self-control from the Intermediate Visual and Auditory Continuous Performance Test, and a count of permanent expulsions from school. The treatment students improved over baseline on 12 variables, while the controls improved on 5 by small amounts and deteriorated from baseline on 8, including teacher-rated violence. There were significant differences between the groups on self-reported happiness and schoolwork and on one measure of attention. After controls took the course, their scores resembled the postcourse scores of the treatment group. Importantly, the control group's increase in teacher-rated violence was reversed. Both groups were then pooled to compare baseline and postcourse teacher ratings. Their scores improved significantly in the areas of resistance to rules, impulsiveness, and inappropriate social behavior. There was also improvement in regard to violence, but the change in scores was not statistically significant. Follow-up on teachers' ratings showed that improvement remained, and in some cases increased, four months after completion of the course. Interestingly, all 6 permanent expulsions were among the control group students who had not yet taken, or had only begun taking, the martial arts course.     

Evaluation of the Responding in Peaceful and Positive Ways (RIPP) Seventh Grade Violence Prevention Curriculum

We evaluated the impact of RIPP-7, a seventh grade violence prevention curriculum designed to strengthen and extend the effects of the sixth grade RIPP-6 curriculum. Classes of seventh graders at two urban middle schools serving predominantly African-American youth where RIPP-6 had been implemented the preceding school year were randomized to intervention (N = 239) and control groups (N = 237). Compared to students in the control group, students who participated in RIPP-7 had fewer disciplinary code violations for violent offenses during the following school year. A limited number of main effects were found on self-report outcome measures and measures of attitudes. Although significant main effects were not found on self-report measures of physical aggression, drug use, or anxiety, analyses of interactions with pretest scores indicated that intervention effects were significantly moderated by pretest scores for several outcome measures. Students most likely to benefit from the intervention were those who reported higher pretest rates of problem behaviors including violent behavior, nonphysical aggression, and delinquent behavior.     

A School-Based Suicide Risk Assessment Protocol

Suicide remains the third leading cause of death among young people in the United States. Considering that youth who contemplate suicide generally exhibit warning signs before engaging in lethal self-harm, school-based mental health professionals can play a vital role in identifying students who are at risk for suicidal behavior. Nevertheless, the assessment of vulnerable children and adolescents is a challenging undertaking, with many variables considered relevant to the determination of a student's suicide risk level. This article introduces school-based mental health professionals to the Student Suicide Risk Assessment Protocol, an evaluation tool developed by the author to aid in the determination of student suicide potential, assist with the selection of appropriate interventions, and allow for documentation of school personnel's actions taken to mitigate a student's suicide risk.     

The Role of Families and Care Givers as Risk and Protective Factors in Preventing Youth Violence

This paper reviews research which discusses the risk and protective functions that families and other caregivers provide in influencing the development of aggressive behavior in youth. Currently, there is an emphasis on providing violence prevention programs in the school environment, typically with little parental or caregiver involvement. By enhancing the role of families and caregivers in youth violence prevention programs, we assert that an unique opportunity exists to both address specific risk factors for violence while enhancing the protective features of the family. Relatedly, the risk literature on youth violence indicates that the most influential risk factors (i.e., the family, community, and peers) have their principle impact on youth aggression outside the school. We suggest a shift in the focus of violence prevention programming that is more inclusive of families as both a risk and protective agent. In support of this position, relevant theory and reviews of exemplary family-involved programs are offered. Challenges to involving youth caregivers are identified and recommendations for overcoming those challenges suggested. Last, recommendations for future research and public policy in the prevention of youth violence are offered.     

Violence risk assessment and women: predictive accuracy of the HCR-20 in a civil psychiatric sample

Research to date has not adequately demonstrated whether the HCR-20 Violence Risk Assessment Scheme (HCR-20; Webster, Douglas, Eaves, & Hart, 1997), a structured violence risk assessment measure with a robust literature supporting its validity in male samples, is a valid indicator of violence risk in women. This study utilized data from the MacArthur Study of Mental Disorder and Violence to retrospectively score an abbreviated version of HCR-20 in 827 civil psychiatric patients. HCR-20 scores and predictive accuracy of community violence were compared for men and women. Results suggested that the HCR-20 is slightly, but not significantly, better for evaluating future risk for violence in men than in women, although the magnitude of the gender differences was small and was largely limited to historical factors. The results do not indicate that the HCR-20 needs to be tailored for use in women or that it should not be used in women, but they do highlight that the HCR-20 should be used cautiously and with full awareness of its potential limitations in women.     

Incremental validity analyses of the violence risk appraisal guide and the psychopathy checklist: screening version in a civil psychiatric sample

This study compares two instruments frequently used to assess risk for violence, the Violence Risk Appraisal Guide (VRAG) and the Psychopathy Checklist: Screening Version (PCL:SV), in a large sample of civil psychiatric patients. Despite a strong bivariate relationship with community violence, the VRAG could not improve on the predictive validity of the PCL:SV alone, even though the VRAG includes several ostensible violence risk factors other than psychopathy. Moreover, incremental validity analyses indicated that the remaining VRAG items accounted for little or no variance in violent outcomes once psychopathy scores were controlled. Conversely, the PCL:SV continued to account for considerable variance after controlling for the VRAG. These results reflect the limited validity of the VRAG items in civil psychiatric samples beyond the variance that is explained by the PCL:SV alone.     

Immigration, suicidal ideation and deliberate self-injury in the Boston youth survey 2006

The prevalence and immigration-related correlates of deliberate self-injury (DSI) and suicidal ideation (SI) were estimated in a sample of Boston public high school students in 2006. Compared with U.S.-born youth, immigrant youth were not at increased risk for DSI or SI, even if they had experienced discrimination due to their ancestry. By contrast, U.S.-born youth who reported having been discriminated against because of their ancestry had an increased risk of deliberate self-injury (odds ratio [OR] = 3.1, 95% confidence interval [CI] = 1.6-5.9) and suicidal ideation (OR = 2.1, 95% CI = 1.2-3.8). The combination of being U.S.-born and experiencing ancestry-based discrimination identifies youth at increased risk for suicidal behavior.     

Early Predictors of Urban Adolescents’ Community Violence Exposure

This study examined the extent to which individual, peer, and family factors predicted the onset of community violence exposure in middle and high school, as well as the indirect effects of early factors. We were particularly interested in the timing of exposure to community violence during adolescence, and thus conducted survival analyses on data from 632 urban youth, followed from first grade through high school. Early aggressive behavior and poor academic readiness were associated with an earlier onset of community violence exposure in adolescence. The effects of early aggression on community violence exposure and victimization were accounted for, in part, by peer rejection and deviant peer affiliation; there was no evidence of moderation by gender or parental monitoring. Findings highlight potential targets for preventive interventions with youth at risk of community violence exposure.     

High school bullying as a risk for later depression and suicidality

This is the first study to examine whether high school students experiencing frequent bullying behaviors are at risk for later depression and suicidality. A total of 236 students who reported frequent bullying behavior without depression or suicidality during a suicide screening were interviewed 4 years later to reassess depression, suicidal ideation, attempts, substance problems, and functional impairment and were compared to at‐risk youth identified during the screen, including 96 youth who also experienced bullying behavior. Youth who only reported frequent bullying behaviors (as bullies, victims, or both) did not develop later depression or suicidality and continued to have fewer psychiatric problems than students identified as at‐risk for suicide. Students who experienced bullying behaviors and depression or suicidality were more impaired 4 years later than those who had only reported depression or suicidality. Thus, assessment of bullying behaviors in screening protocols is recommended.     

Appraisal of suicidal risk among adolescents and young adults through the Rorschach test

The aims of this study are to investigate suicidal behaviors among adolescents and young adults and to test an index composed using Rorschach test responses related to an increased risk of suicide. Using a cross-sectional design, 4 groups were studied (according to criteria of the Columbia Classification Algorithm of Suicide Assessment [Posner, Oquendo, Gould, Stanley, & Davies, 2007]): A group with suicidal ideation (n = 30), a group with parasuicidal behavior (n = 30), a group with near-lethal suicide attempts (n = 26), and a control group (n = 30). Responses to the Rorschach test yielded 6 potential indicators of suicidal behavior (scored according to Exner's Comprehensive System and the Suicidal Index for Adolescents; Silberg & Armstrong, 1992 ). Rorschach scores including at least 4 of these 6 indicators selected 69% of the people who had committed serious suicide attempts. The Rorschach Suicidal Index reached an acceptable reliability and was related to other criteria of suicide risk, such as the Beck Depression Inventory (BDI; Beck, Ward, Mendelsohn, Mock, & Erbaugh, 1961) and Linehan Reasons for Living Inventory (RFL-I; Linehan, Goodstein, Nielsen, & Chiles, 1983). Moreover, the Rorschach Suicidal Index showed incremental validity over the BDI and the RFL-I to predict suicidal behavior. A path analysis additionally showed that low social support was an important mediator between the Rorschach Suicidal Index and the number of suicide attempts committed by participants.     

Predicting physically violent misconduct in prison: A comparison of four risk assessment instruments

Violence in correctional facilities is an important issue for both prisoners and prison staff. Risk assessment instruments have demonstrated their accuracy in predicting the risk of (re) offending and institutional violence in psychiatric settings, but less is known about their ability to predict violent misconduct in prison. The present study applied four risk assessment instruments (Structured Assessment of Protective Factors for violence risk, Historical Clinical Risk Management‐20, Psychopathy checklist – Revised, and Violent Risk Appraisal Guide) to 52 violent offenders in a Swiss prison in order to evaluate the instruments' predictive validities. Outcomes were instances of physically violent, other and any misconduct as recorded in prison files during the 12 months following the prisoners' assessments. Approximately 15% of offenders committed physically violent misconduct and approximately 42% committed any misconduct. The results show that mainly dynamic assessment tools are as good predictors of physically violent misconduct as mainly static assessment tools. Targeting dynamic factors could increase the effectiveness of interventions to reduce the risk of physical violence in prison.     

The relation of age, gender, ethnicity, and risk behaviors to self-esteem among students in nonmainstream schools

This cross-sectional study investigated self-esteem in relation to age, gender, ethnicity, and risk behaviors among a sample of nonmainstream students. Participants were 149 students in the 6th to 12th grades from two nonmainstream schools (one charter and one alternative school). Self-esteem and youth risk behaviors were determined by using a modified version of the Rosenberg Self-Esteem Scale (Rosenberg, 1965) and the National Alternative High School Youth Risk Behavior Survey (Grunbaum et al., 1999), respectively. Results indicated that nonmainstream students with high self-esteem were more likely to engage in their first sexual experience and to begin marijuana use later in life. African American students reported having their first sexual experience at an older age, but having more sexual partners than did Latino students. The implications of these findings are discussed.     

Emotional and behavioral impact of exposure to community violence in inner-city adolescents

Used multiple methods and measures (i.e., youth report, psychiatric interviews, psychophysiological assessment) to investigate the emotional and behavioral impacts of exposure to community violence. Participants were 185 inner-city high school students (M age = 15.4 years; 42% female; 90% African American). Youth with high levels of community violence exposure reported more fears, anxiety, internalizing behavior, and negative life experiences than those with low exposure. No depression or externalizing behavior differences were observed. In a psychophysiological assessment in which adolescents watched a montage of media violence, youth exposed to high levels of community violence had lower baseline heart rates than those with low exposure. There were no between-group differences in physiologic reactivity. Regression analyses revealed that community violence exposure predicted posttraumatic stress and separation anxiety symptoms. The results suggest a significant link between community violence exposure and anxiety symptomatology. Clinical implications are discussed.     

Violence risk appraisal of male and female youth, adults, and individuals

Data from youth (n = 1,127), adults (n = 1,595), and individuals (N = 2,722, combined youth and adults) were followed 3 to 12 years in records to develop items to predict abuse, violence, and homicide in these 3 relevant groups for risk appraisal or safety scales. Shao's bootstrapped logistic regression yielded 14 predictors for youth (AUC = .91), 11 for adults (AUC = .99), and 13 for individuals (AUC = .96). Three regression equations were cross-validated with in-bag and out-of-bag techniques. Pearson coefficients were computed with intelligence, achievement, adaptive behavior, and perception tests. Test-retest reliability was acceptable. Using case-control quasi-experimental design, this study extends probation-parole decision-making tests to infants and children as young as 3 years, with convergent and divergent validity and reliability with other tests. Sensitivity and specificity were high and minimized over- or under-identification challenges in identifying potentially violent persons in the general population.     

Applicability of two violence risk assessment tools in a psychiatric prison hospital population

The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, “FoVOx,” and Mental Illness and Violence Tool, “OxMIV”) were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)—for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80–0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry.     

Predictors of violence exposure among inner-city youth

Examined the ability of demographic variables and risk factors (parental substance use, number of people in the home, out-of-home placements, grades repeated, arrest history, and total life stress) to predict exposure to community violence among 342 high school students from inner-city Baltimore referred for mental health care in community centers or in the schools. Over 90% of the sample knew at least 1 victim of a violent act, 77% reported witnessing a violent act, and 47% reported past victimization by violence. Risk variables were more powerful regression predictors of violence exposure than demographic characteristics such as race, sex, or clinical setting. Even after controlling for demographic differences in violence exposure, risk factors as a group accounted for another 10% to 15% of variance. Life stress was the most consistent predictor of violence exposure for this sample, and life stress was the only variable to make a significant unique contribution to the prediction of all 4 violence criteria.     

Taking “the boss” into the real world: Field interrater reliability of the Short‐Term Assessment of Risk and Treatability: Adolescent Version

There is emerging evidence that the performance of risk assessment instruments is weaker when used for clinical decision‐making than for research purposes. For instance, research has found lower agreement between evaluators when the risk assessments are conducted during routine practice. We examined the field interrater reliability of the Short‐Term Assessment of Risk and Treatability: Adolescent Version (START:AV). Clinicians in a Dutch secure youth care facility completed START:AV assessments as part of the treatment routine. Consistent with previous literature, interrater reliability of the items and total scores was lower than previously reported in non‐field studies. Nevertheless, moderate to good interrater reliability was found for final risk judgments on most adverse outcomes. Field studies provide insights into the actual performance of structured risk assessment in real‐world settings, exposing factors that affect reliability. This information is relevant for those who wish to implement structured risk assessment with a level of reliability that is defensible considering the high stakes.     

A review of research on bullying and peer victimization in school: An ecological system analysis

Bullying and peer victimization in school are serious concerns for students, parents, teachers, and school officials in the U.S. and around the world. This article reviews risk factors associated with bullying and peer victimization in school within the context of Bronfenbrenner's ecological framework. This review integrates empirical findings on the risk factors associated with bullying and peer victimization within the context of micro- (parent–youth relationships, inter-parental violence, relations with peers, school connectedness, and school environment), meso- (teacher involvement), exo- (exposure to media violence, neighborhood environment), macro- (cultural norms and beliefs, religious affiliation), and chronosystem (changes in family structure) levels. Theories that explain the relationships between the risk factors and bullying behavior are also included. We then discuss the efficacy of the current bullying prevention and intervention programs, which is followed by directions for future research.     

Developmental Pathways to Conduct Problems: A Further Test of the Childhood and Adolescent-Onset Distinction

This study tested several theoretically important differences between youth with a childhood-onset and youth with an adolescent-onset to their severe conduct problems. Seventy-eight pre-adjudicated adolescent boys (ranging in age from 11 to 18) housed in two short-term detention facilities and one outpatient program for youth at risk for involvement in the juvenile justice system participated in the current study. The sample was divided into those with a childhood-onset to their serious conduct problem behavior (n = 47) and those with an adolescent-onset (n = 31). The childhood-onset group showed greater levels of dysfunctional parenting, callous–unemotional traits, and affiliation with delinquent peers. The only variable more strongly associated with the adolescent-onset group was lower scores on a measure of traditionalism.