OJJDP Bulletin -- August 2004 -- Assessing the Mental Health Status of Youth in Juvenile Justice Settings

Recommendations for Juvenile Justice Mental Health Assessment

The findings of the present study shed light on the prevalence of mental health disorders among youth in the juvenile justice system. Consideration of the ways in which case identification is affected by the assessment method used suggests the following best practices for clinical assessment in different justice settings:⁸

Mental health assessments should be based on multiple methods of evaluation and on the input of multiple informants. A structured interview is one important component of a mental health assessment. Other important components include direct observation, a mental status examination, chart review, an interview with parent(s) or caregiver(s), and obtaining a family psychiatric and psychosocial history.
Assessments should be based on reliable and valid instruments. Use of a common assessment “language” eliminates uncertainty about the criteria used to determine diagnoses and enables comparison across studies and facilities.
Assessments should include parental input. Parental input is valuable in diagnosing certain disorders, particularly ADHD. Incorporating parental reports into mental health assessments of youth in the justice system is complicated by several factors, including parents’ unavailability or reluctance to incriminate their children. The accuracy of parental reports may also be limited due to parent-child separation. However, when parental and youth reports of ADHD symptoms are combined, increased rates of this disorder are detected (Garland et al., 2001).
Assessments should focus on recent symptoms in order to determine current treatment needs. Depending on the purpose of the assessment and the setting in which it takes place, the timeframe for diagnostic status might vary from the past year to the past month. Assessments should be driven by practical decisions that take into consideration needs at various stages of justice system processing. For example, assessments might aim to accurately identify at least two groups of youth: (1) those whose mental health needs should be met quickly, such as youth who recently have attempted suicide or who currently suffer from a panic disorder or substance dependence, and (2) those who need close supervision and regular reassessment, such as youth with less severe disorders (e.g., depression or posttraumatic stress disorder) that may worsen under the stress of confinement.
Some youth should be reassessed periodically. Youth should be reassessed regularly when they are held in custody over an extended period of time, as symptom profiles may shift. Mood disorders and anxiety disorders, in particular, may wax and wane over time.

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Assessing the Mental Health Status of Youth in Juvenile Justice Settings	OJJDP Bulletin • August 2004