Neurodisability among Children at the Nexus of the Child Welfare and Youth Justice System

Prevalence and correlates of post-traumatic stress disorder and depression among welfare- and justice-involved adolescents in Nigeria

Background: Childhood maltreatment (CM) is higher among welfare- and justice-involved youth than in those not involved in these systems, which increases the risk of depression and post-traumatic stress disorder (PTSD). However, the mechanisms underlying the link between CM and these two psychiatric conditions are less well understood among at-risk populations in low- and middle-income countries.Objective: This study attempts to fill this gap by examining the prevalence of and risk factors for depression and PTSD among at-risk groups in Nigeria.Method: A cross-sectional research design using multistage sampling was adopted. The sample comprised 205 adolescents: justice-involved [102 (49.8%)] and welfare-involved [103 (50.2%)]. In total, 151 (73.7%) were males, while 54 (26.3%) were females. Multivariate logistic regression analysis and multivariate analysis of variance were applied.Results: The results showed that 66.1% of welfare-involved adolescents and 69.6% of justice-involved adolescents reported PTSD, while 68.9% of welfare-involved adolescents and 75.5% of justice-detained adolescents reported depression. Neglect (OR = 0.253; 95% CI 0.146-0.571; p < .001) and witnessing violence (OR = 0.230; 95% CI 0.114-0.597; p < .004) predicted depression. Emotional abuse (OR = 0.186; 95% CI 0.090-0.80; p < .015), witnessing violence (OR = 0.147; 95% CI 0.014-0.876; p < .043), neglect (OR = 0.187; 95% CI 0.14-0.90; p < .008), and physical abuse (OR = 0.27; 95% CI 0.254-0.937; p < .001) predicted PTSD. Also, PTSD significantly differed based on type of placement (F = 6.08, p < .014, η2 = .029), but depression did not differ based on type of placement (F = 2.46, p > .118, η2 = .012).Conclusions: CM profiles are risk factors in PTSD and depression among at-risk groups. CM screening should be included in mental health services of out-of-home placements to prevent the cycle of mental health problems and reoffending. Trauma-focused and cognitive-behavioural therapies have the potential to alleviate the suffering of traumatized adolescents.

Thriving Beyond Adversity: A Prospective Longitudinal Cohort Study Using a Strength-Based Approach Depicts Indigenous Adolescents with Less Adverse Childhood Experiences (ACEs) Had Fewer Neurodevelopmental Disorders (NDDs)

Improving social and emotional well-being (SEWB) among Indigenous adolescents is crucial. Since neurodevelopmental disorders (NDDs) are common in Indigenous people and adverse childhood experiences (ACEs) are important contributors to negative health outcomes throughout the lifespan, we investigated whether limited ACE exposure is associated with reduced risk of NDDs in Australian Indigenous teens using the data from multiple waves (Wave 1 to Wave 9, and Wave 11) of the Longitudinal Study of Indigenous Children (LSIC). We also examined the role of other protective factors, such as Indigenous cultural identity and school connectedness, against NDDs. A strengths-based approach using mixed-effects logistic regression models examined the protective effect of limited ACE exposure (from LSIC waves 1-9) on NDDs (outcome from LSIC wave 11), adjusting for sociodemographic factors. The NDDs included autism, ADHD, intellectual, neurological, and specific learning disabilities. Of the 370 individuals analysed, 73.2% valued Indigenous cultural identity, and 70.5% were strongly connected at school. More than one-fourth (27.8%) reported limited ACE exposure, while the majority was not diagnosed with NDDs (93%). Longitudinal analysis revealed limited ACE exposure was 6.01 times (95% CI: 1.26-28.61; p = 0.024) more likely to be protective against NDDs compared to those exposed to multiple ACEs. Moreover, valuing cultural identity (aOR = 2.81; 95% CI: 1.06-7.39; p = 0.038) and girls (aOR = 13.88; 95% CI: 3.06-62.84; p = 0.001) were protective against NDDs compared to their respective counterparts. Our findings highlight the need to prevent ACE exposure and promote Indigenous cultural identity in preventing negative health outcomes and the exacerbation of health inequities to strengthen the SEWB of Indigenous communities.

From Care to Corrections: A Scoping Review of Pathways from Child Protection to Adult Criminal Justice Systems

Individuals who have experienced child protection system involvement are over-represented in criminal justice systems. This group faces greater risks of serious offending and justice system entrenchment relative to their peers without child protection system contact. Understanding the pathways from child protection to adult criminal justice system contact is critical for informing crime prevention policy and practice, yet most research on the maltreatment-offending relationship solely focuses on children's pathways from child protection to youth justice systems. This scoping review identified and synthesized evidence from studies examining adult justice system contact among individuals who have experienced child protection system involvement (including placement in out-of-home care [OOHC]). A search of six databases identified 7,599 publications, of which 37 met the inclusion criteria. These primary studies included adult participants with a history of child protection system involvement and adult criminal justice system contact (defined by administrative records or self-reported arrest, conviction, or incarceration). The review identified that many factors associated with increased likelihood of adult criminal justice system contact reflect those identified for youth justice involvement (e.g., male gender, racial minority or Indigenous status, a history of substantiated maltreatment, particularly physical abuse, placement in OOHC, particularly placement in residential care, placement for reasons of problem behavior, initial placement in early adolescence, and placement instability). While youth justice system contact is associated with increased risk, engagement in education or employment (for males), and becoming a parent appear to be associated with decreased risk of criminal justice system contact among adults previously involved in child protection systems.

Looked after children in prison as adults: life adversity and neurodisability

PURPOSE

Looked after children (LAC) are criminalised at five times the rate of children in the general population. Children in contact with both child welfare and child justice systems have higher rates of neurodisability and substance use problems, and LAC in general have high rates of school exclusion, homelessness and unemployment. This study aims to understand whether these factors persist in LAC who are in prison as adults.

DESIGN/METHODOLOGY/APPROACH

Administrative data collected by the Do-IT profiler screening tool in a prison in Wales, UK, were analysed to compare sentenced prisoners who were LAC (n = 631) to sentenced prisoners who were not LAC (n = 2,201). The sample comprised all prisoners who were screened on entry to prison in a two-year period.

FINDINGS

Prisoners who were LAC scored more poorly on a functional screener for neurodisability (effect size = 0.24), and on four self-report measures capturing traits of dyslexia (0.22), attention-deficit hyperactivity disorder (0.40), autism spectrum disorders (0.34) and developmental co-ordination disorder (0.33). Prisoners who were LAC were more likely to have been to a pupil referral unit (0.24), have substance use problems (0.16), be homeless or marginally housed (0.18) and be unemployed or unable to work due to disability (0.13).

ORIGINALITY/VALUE

This study uniquely contributes to our understanding of prisoners who were LAC as a target group for intervention and support with re-integration into the community upon release. LAC in prison as adults may require additional interventions to help with employment, housing and substance use. Education programmes in prison should screen for neurodisability, to develop strategies to support engagement.

Gender Differences in the Maltreatment-Youth Offending Relationship: A Scoping Review

Maltreated and child welfare-involved youth are over-represented in juvenile justice systems. These youth are at a greater risk of serious offending and justice system entrenchment relative to their non-maltreated peers. Understanding gender differences in the pathways to justice involvement and the nature of offending among maltreated children is critical for informing policy and practice. Yet, this body of evidence is fragmented. This scoping review identified and narratively synthesized evidence from studies reporting on gender differences in the individual characteristics, maltreatment experiences, child protection involvement and offending profiles of maltreated youth who offend. A comprehensive search of four databases generated 11,568 publications, from which 180 met the review's inclusion criteria. These primary studies included participants aged 8-21 years with a history of childhood maltreatment and youth offending and reported at least one gendered analysis. Some consistent findings were reported across studies. A greater level of child welfare involvement and maltreatment exposure (particularly sexual abuse and multi-type maltreatment) was found for justice involved girls, relative to boys. Maltreated and child welfare-involved boys appear more likely to offend than girls, but findings about how gender moderates the maltreatment-offending relationship were inconsistent. Child welfare systems involvement (particularly foster care and residential care) appeared to be an important moderator for girls, and school performance mediated outcomes for boys. Across this body of evidence, few studies accounted for under-reporting of abuse and neglect when using youth self-report measures of maltreatment. Future research is needed which explicitly explores how gender moderates the maltreatment-offending relationship.

From guidelines to practice: A retrospective clinical cohort study investigating implementation of the early detection guidelines for cerebral palsy in a state-wide early intervention service

OBJECTIVES

To report on knowledge translation strategies and outcomes from the implementation of the early detection guidelines for cerebral palsy (CP) in a state-wide tertiary early intervention (EI) service and investigate the impact of social determinants on clinical services.

DESIGN

Retrospective longitudinal cohort study.

SETTING

The Western Australia tertiary paediatric EI service.

PARTICIPANTS

EI clinicians, consumers and children using the EI service.

OUTCOME MEASURES

Knowledge translation strategies including consumer perspectives, clinician training and Communities of Practice (CoP) guided implementation. We measured changes in referral number and age, delivery of early detection and intervention following the implementation of the guidelines. Exposure to adverse childhood experiences (ACEs), appointment non-attendance (DNA) rates, remoteness and socioeconomic quintiles were used to measure social determinants of health using negative binomial (Incidence Rate Ratios, IRR) and logistic regression (Odds Ratios, ORs).

RESULTS

Ten consumers participated in Focus Groups, 100 clinicians were trained and 22 clinicians established a monthly CoP. Referrals increased fourfold to 511 children. Corrected gestational age at referral decreased from a median of 16.1 to 5.1 months (p<0.001) and at first appointment from 18.8 to 6.8 months (p<0.001). Children living in social disadvantage had the highest DNA risk (quintile 1 vs 5: IRR 2.2, 95% CI 1.1 to 4.6, p=0.037). Children exposed to ACEs had higher odds of living in social disadvantage (quintile 1 vs 5, OR=3.8, 95% CI 1.4 to 10.0, p=0.007). No significant association was found between remoteness and DNA rate or ACE score.

CONCLUSIONS

Implementation strategies reduced referral age and improved the delivery of early detection assessments. Further investigation of the association between social disadvantage, DNA risk and ACE score is required in the development of a state-wide early detection network.

Language disorder and internalizing mental health problems in youth offenders: A systematic review

BACKGROUND

The prevalence of language disorder in youth offenders far exceeds rates reported in community samples. Youth involved in the justice system are also at increased risk of a range of psychiatric disorders, including internalizing mental health problems (i.e., anxiety, depression). However, the frequency with which these co-occur in this population is not known. Understanding the co-occurrence of language disorder with anxiety and depression in youth offenders may contribute to more coordinated and targeted support for these vulnerable youth.

AIMS

To explore the co-occurrence of language disorder and anxiety and depression in youth offenders.

METHODS & PROCEDURES

A systematic literature search of six databases (CINAHL, ERIC, Medline, PyscINFO, PubMED, Scopus) was conducted (September 2021) using key search terms relevant to the systematic review question. Study inclusion criteria were: (1) original research published in English; (2) youth up to 21 years of age involved in the justice system; and (3) reported outcomes on language and anxiety and/or depression. All included studies were appraised using the Joanna Briggs Critical Appraisal tool checklist relevant to study design. Due to the heterogeneity of included studies, data synthesis was narrative.

MAIN CONTRIBUTION

Eight studies met the eligibility criteria. A range of measures was used to assess language abilities across samples. Only two studies directly addressed the relationship between language disorder and internalizing mental health problems; both found no significant correlation.

CONCLUSIONS & IMPLICATIONS

Although the results did not support a significant relationship between language disorder and internalizing mental health problems in youth offenders, the two appear to occur comorbidly as evidenced by heightened rates of both in the included samples. This review highlights the need for more robust studies aimed to better understand this relationship. Stronger evidence may contribute to increased collaborative speech pathology and psychology services which might increase youth offenders' accessibility and engagement in intervention programmes (e.g., cognitive-behaviour therapy; interpersonal skills training; individual counselling).

WHAT THIS PAPER ADDS

What is already known on this subject The markedly high rates of language disorder in youth involved in the justice system have been widely reported. It is also known that externalizing mental health problems often bring youth in contact with the justice system. Though there is some information about the prevalence of internalizing mental health problems in this population, the co-occurrence of language disorder and internalizing mental health problems has not been examined as widely. What this study adds to existing knowledge This study aimed to identify the frequency of co-occurrence of language disorder and anxiety and/or depression in youth offenders. Although the results did not support a significant relationship between language disorder and internalizing mental health problems in this population, results of the review provide evidence of heightened rates of both. This study also provides a summary of the various measures used to assess language and internalizing mental health in youth offenders across the eight studies included in this review. What are the potential or actual clinical implications of this work? It is possible that the tests and sub-tests used to identify language disorders and internalizing mental health problems were not sensitive enough to identify the full extent of youth offenders' needs. Identifying the presence of language disorders and internalizing mental health problems and recognizing the impact these may have on the communication and behaviours of an individual can better inform staff and therapists as they engage and interact with youth in the justice system.

Evidencing the Need to Screen for Social Determinants of Health Among Boys Entering a Juvenile Prison: A Latent Profile Analysis

Social determinants of health influence who ends up in the juvenile legal system and how individuals fare when entering and leaving the system. The present study utilized latent profile analysis to determine the extent to which social determinants of health were present in a sample of incarcerated youth and the patterns in which they appear. The authors then examined their relationships to racial groups, depression, substance misuse, and recidivism risk. Data were from 1288 adolescent boys sentenced to a juvenile prison in one Southeastern state for serious offending (i.e., repeat offenses, offenses involving physical or sexual violence). We ran a latent class analysis to test for patterns with which youth present with various social determinants of health. Profiles with more violence exposure and higher social support were comprised of more Black boys than the referent profile. Property and sexual offenses also differed significantly from the referent profile. Altogether, results from our examination of selected social determinants of health indicated such factors meaningfully contribute to our understanding of experiences of young people in the juvenile legal system and may be targets for mental health and substance use intervention as they may contribute to problem behaviors or negative outcomes.

Piloting an Evidence-Based Assessment Protocol for Incarcerated Adolescents

Although evidence-based assessment is considered an essential component of evidence-based practice, few adolescents have access to evidence-based assessment. Despite experiencing high rates of mental health disorders, incarcerated justice-involved adolescents are rarely able to access evidence-based psychiatric care. In this article, we discuss the components of an evidence-based assessment protocol designed and piloted with incarcerated adolescents involved in Rhode Island's juvenile justice system. In particular, we describe the components of our evidence-based protocol, ways in which evidence-based assessment may need to be modified when working with this population, and discuss policy and clinical implications relevant to increasing access to evidence-based assessment among incarcerated adolescents.

Suicidal behaviour in Aboriginal and non-Aboriginal young men under custodial youth justice supervision: understanding the role of adverse childhood experiences

This study examined the association between adverse childhood experiences (ACEs) and suicidal behaviour in a sample of 1726 young men in an Australian youth justice detention population. Nine ACEs, including child abuse and parental risk factors, were examined. Analyses focused on whether ACEs were associated with suicidal ideation and attempts after controlling for other known correlates including substance use, aggression and out-of-home care exposure. Aboriginal and Torres Strait Islander young men were found to have a higher prevalence and a higher average score of ACEs, but differed very little in relation to reported suicidal behaviour. Higher ACEs scores and specific maltreatment types (i.e. physical and sexual abuse) were positively associated with suicidal behaviour. This relationship was attenuated after controlling for established correlates of suicidal behaviour. The findings underscored the importance of understanding ACEs as major risk factors for suicide in youth justice populations and the need for effective prevention measures.

Determinants and Outcomes of the Therapeutic Alliance in Treating Justice-Involved Youth: A Systematic Review of Quantitative and Qualitative Research

A large body of research supports the role of the therapeutic alliance in predicting positive change in psychotherapy. This systematic review examined determinants of alliance quality and its association with treatment outcomes in an under-served and under-researched population-justice-involved youth-with whom several challenges and contextual considerations arise that bear relevance to the alliance. The search strategy yielded 23 independent studies meeting eligibility criteria and describing diverse treatments: 14 quantitative records synthesized narratively and nine qualitative studies that underwent thematic analysis. A complex picture emerged, precluding firm conclusions about factors linked to enhanced alliances and the alliance-outcome relationship with justice-involved youth. Nevertheless, some promising findings were noted across quantitative studies, including potential treatment benefits related to alliance growth and creating positive alliances with caregivers. The review also highlighted the potential relevance of the young person's relationships with peers and parents and their treatment readiness and expectations to alliance quality. Drawing on adolescent, caregiver, and therapist perspectives, the thematic synthesis of qualitative studies generated themes related to key elements of constructive alliances and their role in creating a foundation for initiating change. An integrated discussion is provided, highlighting practical implications and suggestions for addressing methodological limitations and substantive knowledge gaps.

Advancing Our Understanding of the Risk Factors Associated with Crossover Youth in the Child Welfare and Juvenile Justice Systems: A Trauma-Informed Research Agenda

Previous research has provided robust evidence demonstrating that a notable proportion of youth become involved in both the child welfare (CW) system and the juvenile justice (JJ) system, a population often referred to as crossover youth. Prior work has identified a number of risk factors associated with crossing over between these systems. However, there are limitations to the extant literature, key among which is a lack of systematic attention to the influence of trauma exposure and posttraumatic sequelae on the crossover trajectory. In contrast, viewing this research through a trauma-informed lens promises to enhance our ability to integrate findings across studies and to derive theoretically derived hypotheses about underlying mechanisms which will better inform future research and the development of effective prevention and intervention efforts. Accordingly, the purpose of this article is to present a trauma-informed research agenda that would strengthen future research in the field. After providing a brief critique of the existing studies that has documented known risk factors associated with the crossover population, we outline ways in which future research could apply relevant theoretical trauma-informed approaches, including developmental traumatology, to further advance our knowledge of risk factors and mechanisms associated with the crossover trajectory. We conclude by discussing policy and system-wide implications related to the proposed research agenda.

Strengthening the Connection Between Acquired Brain Injury (ABI) and Family Violence: The Importance of Ongoing Monitoring, Research and Inclusive Terminology

Family violence (FV) harms communities worldwide so FV prevention strategies and effective responses are urgently needed. This article reports on FV apparent in a study which explored the experiences of people with both ABI and justice system encounters in Victoria, Australia. One hundred interviews and one focus group consulted people with ABI, their families and carers, and various stakeholder groups in the Victorian justice system in Australia. Qualitative content analysis determined dominant themes and sub-themes and the less common themes. Inductive interpretive content analysis identified themes commonly found in previous published research and themes that appeared unique to, or unanticipated in, our data, such as the FV theme upon which this article focuses. Our findings reveal that FV has adversely affected many people with ABI who came into contact with Victoria's justice system. Further, as ABI and FV often co-occur with substance abuse, mental health problems, socio-economic and many other significant disadvantages, for some FV perpetrators with an ABI, their ABI symptoms and characteristic co-morbidities may be a mitigating factor in their offending. The connection between ABI and family violence emerged as a troubling research theme. Indeed, the impact of FV on too many of our participants with an ABI compels us to call for further related research and secondary prevention programs targeted at FV victims, and offenders, living with ABI. An intersectional understanding of family violence and TBI/ABI in social ecological contexts is required to better understand brain injury at both individual and population levels.