OVERVIEW OF PROJECTS

The broad purpose of the study discussed here is to provide information relevant to the design of community-based interventions and legal policy for repeatedly violent mental patients. Considerable progress has been made in the past two decades on the development of methods for classifying mental patients according to their risk for involvement in violence in the community. These research programs have produced impressive strategies for assessing the relative   risk status of patients  seen in the civil and forensic hospital systems. However, even patients with a general high risk status (i.e., those in a group of people who have a high likelihood for being involved in a serious violent act over a given time period in the future), are going to be living and treated in the community; being high risk does not translate into indefinite incarceration. In order to design effective treatment interventions for these individuals in the community, we must develop methods for determining when an individual patient is at heightened or lowered risk of being involved in violence (that is, when a patient is in an increased or decreased risk state for violence), and what factors promote these fluctuations in risk state. If patients who are repeatedly involved in violence are being treated in the community, clinicians must know what to monitor as indicators of increased risk state and what aspects of the individual's life to focus upon to reduce that risk state. The research necessary to generate information on risk state must follow patients more closely than has been done in prior research to capture any fluctuations in risk for violence over time, as well as the individual and situational correlates of these fluctuations.

This study examines the relationships among violence and possible precipitating factors, such as substance use, treatment involvement, and relationship quality among a group of 133 repeatedly violent patients. We conducted weekly interviews of subjects and collateral reporters (i.e., someone named by the patients who would know what is happening in the life of the patient) for a six month period after the appearance of the patient in a psychiatric emergency room. These interviews give daily accounts of some behaviors (e.g., drinking) and weekly accounts of other behaviors (e.g., symptoms). The goal is to assess the effects of short term change in behaviors (e.g., drug use) or shifts in clinical status (e.g., symptomatology) for their impact on the likelihood of violence. This information is valuable for planning clinical interventions and policy approaches for repeatedly violent patients.

II. Philadelphia Site:
Sonia Cota-Robles, Ph.D., Temple University, Philadelphia
gato@Opus1.com

III. Phoenix Site:
George Knight, Ph.D., Arizona State University

Laurie Chassin, Ph.D., Arizona State University

Sandy Losoya, Ph.D., Arizona State University. sandl@asu.edu

Consultants:
Jeffrey Fagan, Ph.D., Columbia University
Robert Brame, Ph.D., University of South Carolina
Alex Piquero, Ph.D., University of Florida

Funded by:
Office of Juvenile Justice and Delinquency Prevention (OJJDP)
National Institute of Justice (NIJ)
John D. & Catherine T. MacArthur Foundation
Robert Wood Johnson Foundation
William T. Grant Foundation (WTG)
PA Commission on Crime and Delinquency
State of Arizona

Description:

Specific Aims:

Recent debate in the juvenile justice system has focused on what to do about serious adolescent offenders. This debate is occurring, however, with little data on either (a) the patterns of desistance or escalation among serious adolescent offenders or (b) the effects of interventions or sanctions on trajectories of offending from adolescence to adulthood. The present study plans to address these issues by investigating three specific aims:

1. To identify distinct initial pathways out of juvenile justice system involvement and the characteristics of the adolescents who progress along each of these pathways.

2. To describe the role of social context and developmental changes in promoting desistance or continuation of antisocial behavior.

3. To compare the effects of sanctions and selected interventions in altering progression along the pathways out of juvenile system involvement.

General Design

This study will follow 1, 200 serious adolescent offenders from Philadelphia and Phoenix for three years after a court involvement. An equal number of adolescent subjects (n=600) will be drawn from each locale and will range between 14-17 years of age. Two sites were chosen to reduce the possibility that findings would actually reflect (or be construed by the field as reflecting) idiosyncrasies of local practices or offenders. Recruitment of subjects will take place in two sites at each locale - the juvenile court and selected secure facilities serving the court. Recruitment at the court will ensure that the sample will have a sufficient number of subjects who receive community-based interventions or sanctions. Adolescents recruited in the institutions will be required to have the same minimum criminal history and to be in the same age range at the time of their court appearance. These adolescents will be enrolled several months prior to their release and interviewed initially within a month of their release from the institution. We will use stratified sampling by gender and type of sanction/intervention within each site to ensure adequate sample sizes for subgroup analyses. The enrolled adolescents will be offenders with sufficiently serious charges and histories to be relevant for policy discussions, yet heterogeneous enough to provide a picture of the relative impact of interventions, sanctions, and life changes.

Potential subjects will be identified by an initial review of records at each of the juvenile court sites. Each adolescent will be interviewed shortly after their court appearance (a "baseline" interview) and then every six months for three years ("follow-up" interviews). A "collateral" (i.e., someone named by the adolescent as knowing what is going on in his/her life) will be interviewed at baseline and then annually for verification of the occurrence and timing of major changes in the life of the adolescent. In order to better understand youths institutional experiences, a "release" interview will be conducted prior to the subjects departure from a court-ordered placement. In addition, official records will be reviewed for each adolescent at the end of the study period. This will include juvenile and adult arrest records as well as treatment summary reports from any social service agency involvement.

Background characteristics (e.g., service and sanction history), mediating factors (e.g., vocational opportunities), changes in functioning  ( e.g., antisocial/prosocial behavior), and involvement with interventions and sanctions during the follow-up period will be documented. The factors we have chosen to measure in the interviews are those that have empirical support as potentially influential factors related to this transition in late adolescence. We will measure individual characteristics related to successful adaptation during this period and changes in social context likely to have a lasting impact. We have organized these in terms of personal domains, social contexts, interventions, and sanctions.

Theoretical and Practical Significance

The information generated will be useful for both improving juvenile justice and focusing policy debate. It will provide a significant addition to the sparse empirical basis needed to construct useful risk assessment approaches for juvenile justice practitioners and judges. These professionals currently have very limited solid guidance about how to assess the potential utility of different intervention and sanction options. In addition, demonstration of heterogeneity in serious adolescent offenders and of the varying impacts of different interventions and sanctions will refine debate regarding the potential value of individualized approaches in juvenile justice.

In short, the proposed study attempts to provide a rich picture of how serious adolescent offenders change in late adolescence, and the factors that influence these patterns of change.

This project tests the validity of different methods of self-report recall regarding violent incidents. Using a life event calendar approach, data about violent events and other life conditions are collected from individuals who took part in a previous, NIMH-funded  study. In this previous study, researchers interviewed 133 repetitively violent mental patients weekly for six months about changes in their lives and the specific details of their involvement in violent incidents. The current study uses a life-events calendar approach to interview these subjects at a time either one, two, or three years after their last weekly interview. This follow-up allows us to see how well the recall of violent incidents and life situations at this later date compares with reports obtained within seven days of any incidents or life experiences and to augment the information available on the current study subjects.

Specific Aims:

Despite this growing body of evidence regarding the prevalence of mental illness among juvenile offenders and the likely connections between particular disorders and continued offending, little is known about the implications of such widespread mental health problems for the overall development of these adolescent offenders. In addition, little is known about how the available data on mental illness among juvenile offenders can be used to improve treatment, since the relations between mental illness and service utilization have not been systematically explored in this population.

The goals of the present study are as follows:

1. Test the utility and validity of a mental health screen for juvenile detention facilities.

2. Describe the use of clinical evaluations in decision-making by the court, and the relations between these evaluations and the services received by juvenile offenders.

3. Describe the relations between utilization and perception of mental health services and the mental health and psychosocial development of juvenile offenders.

General Design:

The research plan is divided into three separate studies. The first study will screen all youths entering detention centers throughout Pennsylvania for symptoms of mental illness over a 3-year period. For the second study, a sub sample of 198 youths will be selected for more in-depth diagnostic assessment and service utilization interviews. In addition, the psychosocial maturity of these youths will also be assessed. The third and final study will recruit twenty-six members of this sub sample to participate in focus group discussions of their perceptions of services, and an additional 40 youths will be selected to participate in a semi-structured interview on their perception of services. The results of this three-stage study will provide the basis for a longitudinal investigation of the ways in which adolescent development, mental illness, and intervention programs interact to influence the transition to functional adult roles.

Theoretical and Practical Significance

If we are to improve the effectiveness of the juvenile justice system's rehabilitation programs, then we need accurate assessments of both the mental disorders and the service experiences of this population. The first steps in achieving this goal are to detect the prevalence of mental disorders among youths who enter the juvenile justice system, to document the services these youths encounter before, during, and after their initial detention, and to explore the perceptions of offenders regarding these services. These data will not only allow for an evaluation of how well services are matched with the needs of juvenile offenders, but will also serve as a starting point for more detailed analyses of the effectiveness of different services among delinquent populations with diverse mental health conditions. Such data comparing the effectiveness of different treatment approaches would provide juvenile courts with a valuable empirical basis on which to improve disposition decisions.

Overview

Much is known about psychopathy, as assessed by various forms of the Psychopathy Checklist (PCL), and its relation to violence among populations.  However, the construct of "juvenile psychopathy" in general, and its relationship to violence in particular, have only recently become areas of research and public policy interest.

Because adolescence is a time of enormous developmental change, it is imperative that we learn more about the stability, nature, and manifestations of psychopathy  during the adolescent years before embracing the use of this construct as a valid component in the evaluation of juvenile offenders. A compelling place to begin this investigation is with psychopathy as operationalized by the  PCL measures: high scores on these measures have become virtually equated with psychopathy in clinical practice, and the measures have been recommended explicitly for use with juveniles. The goal of the proposed study is to determine whether psychopathy, as assessed by the  PCL measures, is a valid, stable, and useful personality construct when applied to adolescent offenders.

Specific Aims:

This study has three primary goals:

1. To compare adolescents and adults on measures of psychopathy in light of their developmental maturity.

2. To compare adolescents and adults on the relation between psychopathy  and particular types of violence.

3. To describe the stability of psychopathy over time in adolescents and adults.

Study Methods and Resources:

The most appropriate design for addressing the specific aims of the proposed study would be to follow a sample of young offenders until they reach adulthood. However, this method would require waiting several years and devoting substantial resources for an uncertain payoff. Thus, we propose to begin with a cross-sectional comparison of adults and adolescents in order to assess the developmental appropriateness of the   PCL  measures. In addition, we include a limited longitudinal component to assess the short-term stability of this measure. The proposed study will begin to address the complex issues raised above as well as determine whether more detailed investigations are warranted.

This study will recruit 200 male juvenile offenders and 120 adult male offenders. The samples will be divided evenly among "psychopathic" and "non-psychopathic" members, based on established cut points for  PCL scores. Youths will be between the ages of 14 and 17.6 years old and adults will be between the ages of 26 and 29 years old. These ages were chosen to reflect the current policy trends towards adolescent offenders (adolescents in Pennsylvania may be prosecuted as adults beginning at age 14) and to obtain a representative sample of mid-adulthood inmates in the prison system. Interviews assessing psychopathy, developmental maturity, violence, and service experiences will be conducted at baseline, one-month, and one-year.

Implications:

This study will be among the first to define the nature and stability of psychopathy  among adolescent offenders. If   PCL scores are found to predict violence within the institution but to be heavily influenced by developmental maturity and unstable over time, then it may be appropriate to use the measures only to inform decisions with proximate effects, like determining the degree of security for an adolescent's short-term placement. The findings clearly would argue against using   PCL measures to make waiver decisions, which have important long-term effects. On the other hand, if   PCL  measures of psychopathy are found to be unaffected by developmental maturity and stable over a one-year follow-up period, then the measures may be relevant for longer-term risk assessment and decision-making. Regardless of its outcome, this study will advance the field's understanding of the evolution (or lack thereof) of psychopathic characteristics during the adolescent years and inform the debate about the contexts in which measures of psychopathy can appropriately be used to inform decisions about juvenile offenders.

There is limited research addressing the precursors and patterns of offending among females. This is largely due to the scarcity of longitudinal data on female offenders. The data collected by  Glueck and Glueck (1934) for their Women's Reformatory Study provides a unique opportunity to explore the dynamics of female crime. This data set contains extensive retrospective information on the life histories and criminal/delinquent backgrounds of 500 female offenders. In addition, the  Gluecks collected information about the institutional experiences of these offenders and followed them for five years collecting data on their post-parole experiences and offending behavior.

The present study will code and computerize this longitudinal data set into a manageable database that we can use to investigate the factors associated with the onset, persistence, and desistance of female offending. In particular, this study is designed to accomplish four central goals. First, we will develop a computerized version of the data collected for the Glueck and Glueck Women's Reformatory Study that will facilitate analyses of longitudinal patterns of female offending. Second, we will identify the primary factors associated with the onset of both early problem behavior and early contact with the justice system among females as compared to those associated with late onset female offending. Third, we will isolate the central background factors and concurrent life course dynamics correlated with recidivism and desistance among female offenders. Finally, we will examine the unique forces shaping female offending in the early part of the 20th century, before the women's movement substantially changed women's opportunities and related life-course trajectories. The final product will be the revitalization of a historically important data set, which we can use to provide a clearer picture of the pathways into and out of female offending.

The Department of Public Welfare is conducting an evaluation of their Screening and Assessment Demonstration Project. This project involves four detention centers and selected shelters across the state of Pennsylvania (Allegheny, Erie, Chester, and Bucks Counties). The primary goal of this project is to examine how the early identification of mental health and/or substance abuse issues of youth in juvenile detention centers and shelters relate to service experience and treatment. In addition, we are also interested in determining how this information influences judicial decision-making and the disposition of youths. We believe that a timely response to mental health needs will not only increase the appropriateness of services but also improve the coordination of services between the systems that serve dependent and/or delinquent youths.

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Department of Psychiatry ,Thomas Detre Hall of the Western Psychiatric Institute and Clinic, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, (412) 624-2100

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