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Northwestern Juvenile Project Juvenile Detainee Mental Health 2013

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U.S. Department of Justice
Office of Justice Programs
Office of Juvenile Justice and Delinquency Prevention

Melodee Hanes, Acting Administrator

February 2013

Beyond Detention
Even though research indicates that
the majority of youth in the juvenile
justice system have been diagnosed with
psychiatric disorders, reports issued by
the Surgeon General and the President’s
New Freedom Commission on Mental
Health show that juvenile detainees
often do not receive the treatment and
services they need.
This bulletin series presents the results of
the Northwestern Juvenile Project, the
first large-scale, prospective longitudinal
study of drug, alcohol, and psychiatric
disorders in a diverse sample of juvenile
detainees. Individual bulletins examine
topics such as suicidal behaviors in youth
in detention, posttraumatic stress disorder and trauma among this population,
functional impairment in youth after
detention, and barriers for youth who
need to receive mental health services.
Nearly all detained youth eventually
return to their communities and the
findings presented in this series provide
empirical evidence that can be used to
better understand how to meet youth’s
mental health needs and provide appropriate services while in detention and
after their release. The Office of Juvenile
Justice and Delinquency Prevention
hopes this knowledge will help guide
innovative juvenile justice policy and
create a better future for youth with psychiatric disorders in the justice system.

The Northwestern Juvenile Project:
Overview
Linda A. Teplin, Karen M. Abram, Jason J. Washburn, Leah J. Welty, Jennifer A. Hershfield,
and Mina K. Dulcan

Highlights
The Northwestern Juvenile Project (NJP) studies a randomly selected sample
of 1,829 youth who were arrested and detained in Cook County, IL, between
1995 and 1998. This bulletin provides an overview of NJP and presents the
following information about the project:
•	 NJP is a longitudinal study that investigates the mental health needs
and long-term outcomes of youth detained in the juvenile justice
system.
•	 This study addresses a key omission in the delinquency literature.
Many studies examine the connection between risk factors and the
onset of delinquency. Far fewer investigations follow youth after they
are arrested and detained.
•	 The mental health needs of youth detained in the juvenile justice
system are far greater than those in the general population.
•	 The mental health needs of youth in detention are largely untreated.
Among detainees with major psychiatric disorders and functional
impairment, only 15 percent had been treated in the detention center
before release.

Office of Juvenile Justice and Delinquency Prevention

ojjdp.gov

February 2013

The Northwestern Juvenile Project: Overview
Linda A. Teplin, Karen M. Abram, Jason J. Washburn, Leah J. Welty, Jennifer A. Hershfield, and Mina K. Dulcan
The Northwestern Juvenile Project (NJP) is the first
large-scale, prospective longitudinal study of mental health
needs and outcomes of juvenile detainees. The Office of
Juvenile Justice and Delinquency Prevention (OJJDP) and
a consortium of eight other federal agencies and five pri­
vate foundations have funded NJP. Data from large-scale
studies such as NJP provide an empirical basis for decisionmaking in the juvenile justice system.
NJP includes a diverse sample of 1,829 youth who were
arrested and detained between 1995 and 1998 in Cook
County, IL, the metropolitan area that includes Chicago
and its surrounding suburbs. At baseline, the participants
were between 10 and 18 years old.

NJP continuously tracks and reinterviews participants.
Following participants over time allows for the study of
patterns and sequences of disorders, the impact of these
disorders on functioning, and the important risk and
protective factors in this population. Researchers inter­
view participants where they are living (either in their
communities or in correctional facilities). In addition to
conducting face-to-face inter views with participants, NJP
also obtains records from 16 correctional and ser vice agen­
cies to cross-validate self-reported data on criminal justice
involvement and to confirm the use of mental health and
substance use services.

About this series
Studies in this series describe the results of statistical
analyses of the Northwestern Juvenile Project, a longitu­
dinal study of youth detained at the Cook County Juvenile
Temporary Detention Center in Chicago, IL, between 1995
and 1998. The sample included 1,829 male and female
detainees between ages 10 and 18. The data come from
structured interviews with the youth.
Topics covered in the series include the prevalence of
suicidal thoughts and behaviors among juvenile detain­
ees, posttraumatic stress disorder and trauma within this
population, functional impairment after detention (at work,
at school, at home, or in the community), psychiatric disor­
ders in youth processed in juvenile or adult court, barriers
to mental health services, violent death among delinquent
youth, and the prevalence of psychiatric disorders in youth
after detention. The bulletins can be accessed from the
Office of Juvenile Justice and Delinquency Prevention’s
(OJJDP’s) Web site, ojjdp.gov.

2

Juvenile Justice Bulletin

In addition to the funding that OJJDP provided, the
research also was supported by the National Institute on
Drug Abuse, the National Institute of Mental Health, the
National Institute on Alcohol Abuse and Alcoholism, the
Substance Abuse and Mental Health Services Administra­
tion (Center for Mental Health Services, Center for Sub­
stance Abuse Prevention, and Center for Substance Abuse
Treatment), the Centers for Disease Control and Preven­
tion (National Center for Injury Prevention and Control and
National Center for HIV/AIDS, Viral Hepatitis, STD, and
TB Prevention), the National Institutes of Health Office of
Research on Women’s Health, the National Institute on
Minority Health and Health Disparities, the Office of Rare
Diseases, the Office of Behavioral and Social Sciences
Research, the U.S. Departments of Labor and Housing
and Urban Development, the William T. Grant Foundation,
and the Robert Wood Johnson Foundation. The John D.
and Catherine T. MacArthur Foundation, the Open Society
Foundations, and the Chicago Community Trust provided
additional funds.

background
A significant proportion of the nation’s youth are involved
in the juvenile justice system. In 2009, approximately 1.9
million arrests were made of persons younger than age 18;
juveniles accounted for 12 percent of all Violent Crime
Index arrests and 17 percent of all Property Crime Index
arrests nationwide (Puzzanchera and Adams, 2011). In
2010, nearly 71,000 juveniles were in custody on an
average day (Sickmund et al., 2011). Because of the large
number of juvenile detainees, it is important to gather
accurate epidemiologic data on psychiatric disorders.
Comprehensive, accurate, and reliable data are needed
to guide the development of innovative juvenile justice
policy. NJP provides empirical evidence that communities
can use to develop and provide appropriate services within
detention centers. Because the study is longitudinal, it also
provides information about the long-term outcomes of
these youth after they leave detention. Findings from NJP,
to be presented briefly in this bulletin and in greater detail
in subsequent bulletins, provide important information
on how to facilitate successful reentry into the community
and successful transition to adulthood for youth in the
juvenile justice system.

Lewis et al., 1987; McCabe et al., 2002; Steiner, Garcia,
and Mathews, 1997; Timmons-Mitchell et al., 1997). Far
fewer studies, however, have examined how youth fare
after they leave detention. Only two large-scale longitudi­
nal studies of juvenile detainees, in addition to NJP, have
examined psychiatric disorders among youth in the juve­
nile justice system. Table 1 lists key characteristics of these
longitudinal studies and NJP. The Youth Support Project
(Dembo et al., 2000), an intervention study, reported on
substance use, not substance use disorder or other psychi­
atric disorders. The Pathways to Desistance study (Mulvey,
2004) (also funded by OJJDP) sampled only serious of­
fenders; that is, those who were adjudicated delinquent for
felonies or serious misdemeanors. Thus, the Pathways to
Desistance study provides data on an important subgroup,
but one that comprises a relatively small fraction of youth
in the juvenile justice system (Stahl, 2003; Puzzanchera
and Kang, 2011).

NJP’s overall Approach and Goals
NJP was designed to investigate the mental health needs
and long-term outcomes of youth in the juvenile justice
system. NJP has three primar y goals:
1. Assess the prevalence, development, and persistence
of psychiatric disorders as youth in the juvenile
justice system become adults. As part of this goal, the
researchers do the following:

Differences between NJP and
other Longitudinal studies of
Psychiatric Disorder Among
Detained Youth
Many excellent cross-sectional studies have examined men­
tal disorders among detained youth (Atkins et al., 1999;

• Assess affective, anxiety, psychotic, disruptive be­
havior, and substance use disorders; and patterns of
comorbid disorders.

Table 1. Longitudinal Studies of Youth in the Juvenile Justice System1
Sample2
Race/Ethnicity3
Study Name and Location

Type

N

Age

Female

W

A

H

O

Years
Followed

Northwestern Juvenile Project
(Chicago, IL) (Teplin et al., 2002)

Detainees

1,829

10–18

36%

16%

55%

29%

0.2%

16

Pathways to Desistance study
(Philadelphia, PA, and Phoenix,
AZ) (Mulvey, 2004)

Serious
adjudicated
offenders4

1,354

14–18

14%

25%

44%

29%

2%

7

Youth support Project
(Tampa, FL) (Dembo et al., 2000)

Arrestees
entering an
intervention
program

164

10–18

39%

59%

39%

30%

0%

3

1
This table includes studies that (1) were conducted in the United States, (2) had at least a 3-year followup period, (3) had a sample size of at least 100, (4) examined

psychiatric disorder or substance use at two or more points in time, and (5) had one or more publications in a peer-reviewed journal.

2
Demographic characteristics are based on the baseline sample. The sample size at followup(s) may be smaller. Percentages are rounded to the nearest whole number

and may not add to 100 percent.

3

W = Non-Hispanic white, A = African American, H = Hispanic, O = Other racial/ethnic group(s).


4

Participants were predominantly adjudicated of felonies.


Juvenile Justice Bulletin

3

• Examine how incarceration during adolescence af­
fects subsequent psychiatric disorders, gang involve­
ment, criminal behaviors, involvement in the drug
trade, violent perpetration and victimization, and
mortality.
• Study the consequences of incarceration on adult
social role performance, as defined in goal 2 above.
• Examine how factors in adolescence and young adult­
hood influence disproportionate minority contact
with the justice system in adulthood.

sampling and interview Methods
• Examine functional impairment and outcomes associ­
ated with these disorders.
• Focus on gender and racial/ethnic disparities in psychi­
atric and substance use disorders.
• Examine how well community mental health and
justice systems respond to the needs of these youth.
2. Examine the dynamic relationships among patterns
of psychiatric disorders, risky behaviors, mortality,
and other long-term outcomes in adulthood. As part
of this goal, the researchers do the following:
• Examine the development and persistence of risky
behaviors such as gang involvement, criminal activity,
risk behaviors related to sexual activity and drug use,
involvement in the drug trade, and perpetration of
violent crimes.
• Focus on the antecedents of these risky behaviors
(e.g., exposure to violence, abuse, and neglect)
and how different types of risky behaviors are
interrelated.
• Determine the consequences of these behaviors on
adult social role performance: educational attain­
ment, employment, residential independence, inti­
mate relationships, parenting, and desistance from
crime.
3. Examine how patterns of incarceration during ado­
lescence and adulthood affect long-term outcomes
in adulthood. As part of this goal, the researchers do
the following:
• Collect data on age at incarceration, number of
incarcerations and releases, length of incarcerations,
time spent in the community between incarcerations,
terms of release, and experiences with community
corrections (parole, probation, and community
supervision).
4

Juvenile Justice Bulletin

The following section discusses how the researchers carried
out the study, including the demographic characteristics
of the sample, the interview design, and the methods they
used to track and retain sample participants.

Demographic Characteristics
of the Sample
NJP recruited a stratified random sample of 1,829 youth at
intake to the Cook County Juvenile Temporary Detention
Center (CCJTDC) in Chicago, IL, between November 20,
1995, and June 14, 1998. CCJTDC is used for pretrial
detention and for offenders sentenced for fewer than
30 days. To ensure adequate representation of key sub­
groups, researchers stratified the sample by gender, race/
ethnicity (African American, non-Hispanic white, His­
panic, or other), age (10–13 years or 14 years and older),
and legal status (processed in juvenile or adult court).
All detainees awaiting the adjudication or disposition of
their case were eligible to participate in the study. Among
them, the researchers randomly selected 2,275 detainees;
4.2 percent (34 youth and 62 parents or guardians) re­
fused to participate. There were no significant differences
in refusal rates by gender, race/ethnicity, or age. Twentyseven youth left the detention center before an interview
could be scheduled, 312 left while the researchers attempt­
ed to locate their caretakers for consent, and 11 others were
excluded from the sample because they were unable to
complete the interview. The final sample size was 1,829. It
was composed of 1,172 males and 657 females; the ethnic
breakdown was 1,005 African Americans, 296 non-Hispanic
whites, 524 Hispanics, and 4 “other race/ethnicity.” The
age range was 10 to 18 years old with a mean of 14.9
years and a median of 15 years. Sample weights are used
in statistical analyses; therefore, findings reflect CCJTDC’s
population rather than the stratified sample. Table 2 pres­
ents unweighted sample characteristics and figure 1 (page
6) presents information about sample stratification.

• Inclusion of youth processed in juvenile and adult
court. The sample includes youth processed as juveniles
and oversampled those who were transferred to adult
court.

The sample has several strengths:	
•	 Size. The sample is large enough to investigate uncom­
mon risk factors and outcomes.
•	 Large subsample of females. There are enough
females (657, more than one-third of the sample)
to examine gender differences. It is critical to study
females because they comprise a substantial proportion
of persons in the juvenile and adult justice systems: 30
percent of juvenile arrests, 14 percent of juveniles in
residential placement, 25 percent of adult arrests, and
9 percent of incarcerated adults (Puzzanchera, 2009;
Snyder, 2011; Sickmund et al., 2011; Glaze, 2010).

Interviews
Baseline interviews began in November 1995; 13 waves of
followup interviews, spanning 16 years, began in Novem­
ber 1998 and are ongoing.
Researchers conduct followup inter views with participants
where they are living when their interview is due (in the
community or in a correctional facility). A small propor­
tion of participants are interviewed by telephone if face­
to-face inter views are not feasible.

•	 Racial/ethnic diversity. The sample is racially and eth­
nically diverse; it is composed of 1,005 African Ameri­
cans (54.9 percent), 524 Hispanics (28.7 percent), 296
non-Hispanic whites (16.2 percent), and 4 from other
racial/ethnic groups (0.2 percent).

Sample Retention
Sample retention is critical to the integrity of longitudi­
nal data. NJP participants are highly mobile and can be
difficult to locate. The researchers developed an extensive
tracking system to maintain the sample. Participants re­
ceive thank-you notes, birthday cards, and routine mail­
ings with gifts throughout the year. All mailings include

•	 Wide age range. At baseline, the age range was 10 to
18 years old (a mean of 14.9 years). Youth 10 to 13
years old were oversampled to provide adequate num­
bers to examine age differences.

Table 2. Unweighted Sample Characteristics of Study Participants
Northwestern
Juvenile Project (NJP)
Characteristic

National Residential
Placement (1997)3

Sample Size

Percentage of Participants1

CCJTDC Population2

1,172

64.1%

93.4%

86.4%

657

35.9%

6.6%

13.6%

1,005

54.9%

82.7%

39.9%

Hispanic

524

28.7%

11.2%

18.4%

Non-Hispanic White

296

16.2%

5.6%

37.5%

4

0.2%

0.5%

4.2%

372

20.3%

8.6%4

6.5%

1,457

79.7%

91.4%

1,554

85.0%

93.1%5

275

15.0%

6.9%5

Gender
Male
Female
race/ethnicity
African American

Other
Age
10–13
14 and older
Mean

14.9

Median

15

Mode

16

Legal status
Juvenile court
Adult court

4

93.5%

CCJTDC = Cook County Juvenile Temporary Detention Center

1

Percentages may not add to 100 percent due to rounding.


2

Jail breakdown as calculated by NJP.


3

Sickmund et al., 2011.


4

Data were available for males only due to stratification.


5

Data were available for males ages 14 and older only.


Juvenile Justice Bulletin

5

Figure 1. Sample Stratification for the Northwestern Juvenile Project
racial/ethnic Characteristics of Participants
(n = 1,829)

Non-Hispanic
whites in
detention

center

(5.5%)


100

80

80

60

60

Percent

Percent

100

Gender of Participants (n = 1,829)

Males in
detention
center
(92.7%)

40

20

40
20

0

Non-Hispanic
white
(n = 296)

Hispanic
(n = 524)

0

African
American
(n = 1,005)

Age of Participants (n = 1,829)
100

Sample mean = 14.9 years
Sample median = 15 years

80

60

Percent

Percent
Mean age
in detention
center (15.2)

Detention
center youth
processed in
adult court
(6.4%)

20

10

11

12

13

14

15

16

17

18

Age (years)
change of address cards. Returned mail indicates the
participant has been lost to followup and more extensive
tracking procedures are required. Inter viewers update con­
tact information at ever y inter view. To track participants,
researchers use the telephone, Internet, agency contacts,
and contacts the participant has previously provided; they
also visit last-known addresses. Table 3 shows participation
rates (82–97 percent).

Considerations for Measurement
The following goals have guided the choice of measures.
Ensure comprehensiveness. Content areas reflect prior
empirical studies of psychiatric and substance use disor­
ders, criminal recidivism, and risk and protective factors.
6

60

40

40

0

Male
(n = 1,172)

Legal status of Participants (n = 1,829)

100

80

Female
(n = 657)

Juvenile Justice Bulletin

20

0

Adult court
(n = 275)

Juvenile court
(n = 1,554)

Maximize sensitivity. Because many of the participants’
responses score at the extremes of conventional measures
(e.g., very low on cognitive assessments and very high
on many behavioral assessments), the researchers selected
instruments that are sensitive in extreme ranges (Dowling,
Johnson, and Fisher, 1994; Hawkins et al., 2003; Needle
et al., 1995; Weatherby, Needle, and Cesari, 1994). When­
ever possible, the researchers chose instruments designed
for high-risk populations who, on average, have more
verbal deficits than general population youth. As needed,
the research team refined the coding to capture smaller
gradations of symptoms, behaviors, and attitudes.
Minimize cultural bias. Standardized measures in
some areas—demographics, family structure, and family
functioning—are inappropriate for many delinquent youth

because they often do not live in traditional families. It is
common for these youth to live in single-parent house­
holds, move frequently, or be cared for by siblings or
extended family. The researchers revised standard instru­
ments to capture variations in these family systems.
Maximize comparability to the researchers’ baseline
data. In some cases, the research team developed new in­
struments that were superior to those used in the baseline
assessments or that better addressed participants’ evolving
developmental stages. Where they used new instruments,
researchers maximized their comparability to the instru­
ments used at earlier waves.
Maximize efficiency. To complete inter views within the
limits of most participants’ attention span and motivation,
the researchers combined some instruments and con­
densed others, with advice from authors or experts in the
field. Researchers worked with participants to construct a
timeline of events since their last inter view, in the past year,
and in the past 3 months to help them recall the timing of
behaviors throughout the interview. Interviewers con­
ducted reliability checks with mock participants following
training and annually thereafter to maintain consistency.
Maximize comparability to other studies. Whenever
possible, the research team selected commonly used in­
struments to maximize the likelihood that these data could
be compared with other large studies of adolescents and
at-risk populations. NJP draws questions from the Nation­
al Institute of Mental Health’s Methods for the Epide­
miology of Child and Adolescent Mental Disorders study
(Goodman et al., 1998); the National Survey on Drug
Use and Health (Substance Abuse and Mental Health
Ser vices Administration, 2004); the National Institute
on Drug Abuse’s Risk Behavior Assessment (Dowling,
Johnson, and Fisher, 1994; Needle et al., 1995; Weath­
erby, Needle, and Cesari, 1994); the Denver Youth Survey
(Institute of Behavioral Science, 1991); the Seattle Social
Development Project (Hawkins et al., 2003); the Wash­
ington, DC, Metropolitan Area Drug Study of Juveniles
(National Institute on Drug Abuse, 1995); the Child and
Adolescent Functional Assessment Scale (Hodges, 1994);
and the Child and Adolescent Ser vices Assessment–
Modified (Burns et al., 1994).

Statistical Manual for Mental Disorders (DSM–III–R)),
which was the most recent version available (in both Eng­
lish and Spanish) at the time of those assessments (Bravo
et al., 1993; Shaffer et al., 1996). The DISC is a highly
structured diagnostic interview that contains detailed
probes into symptoms.
For followup interviews, the research team modified diag­
nostic assessments in accordance with improvements in di­
agnostic technology and the age of participants. The team
administered the DISC version 4.0 (DISC–IV, which is
based on the DSM–IV), which its authors modified for use
with young adults, at the followup inter views (Fisher et al.,
1997; Shaffer et al., 2000). In addition, the team used the
Diagnostic Inter view Schedule, version IV (DIS–IV, which
is based on the DSM–IV) to assess disorders that either
were not assessed or that the DISC–IV did not adequately
assess, including substance use disorders, schizophrenia,
cognitive impairment, and antisocial personality disorder
(Shaffer et al., 2000).
By 2002, most of the participants in the sample were
18 years old or older, at which time NJP stopped using
diagnostic tools designed for children and adolescents
and began administering the World Mental Health–
Composite International Diagnostic Inter view (WMH–
CIDI) for adults. The researchers use the WMH–CIDI
to assess the following DSM–IV disorders: depression,
mania, panic, generalized anxiety, and posttraumatic stress
disorder (PTSD), as well as suicidality (Kessler and Üstün,
2004). The WMH–CIDI is a comprehensive measure that
Table 3. Participation Rates
Followup
Interview1
(years)
3

Diagnostic Measures
NJP employs standardized diagnostic instruments that are
appropriate for the developmental stage of the participants
at each wave. The baseline assessments used the Diagnos­
tic Inter view Schedule for Children (DISC), version 2.3
(based on the revised third edition of the Diagnostic and

Type
Full

Interviews Completed

N

N

Percent3

1,829

1,751

97.5%

3.5

Subsample

997

942

95.5%

4

Subsample

997

914

93.1%

Full

1,829

1,625

91.5%

Full

1,829

1,489

84.2%

Full

1,829

4.5
6
8

The sidebar “Northwestern Juvenile Project: Key Areas of
Measurement” (pages 8–9) lists key variables that NJP assesses.

Planned Sample2

4
4

1,442

82.3%

10

5

Subsample

800

655

85.5%

11

Subsample5

800

667

87.4%

12

Full

1,829

1,520

87.7%

1
The 13- to 16-year followup interviews are ongoing; participation rates are not
yet available.
2

Number of interviews planned for the followup.

Number of interviews completed divided by the number of participants still
living at the close of the followup. Some participants completed interviews
beyond the interview window.
3

4
The 3.5- and 4-year followup interviews include only a random subsample of
participants (n = 997).
5
The 10- and 11-year followup interviews include only participants who had
received the HIV/AIDS assessment at baseline (n = 800).

Juvenile Justice Bulletin

7

NorthwesterN JuveNiLe ProJeCt: KeY AreAs of MeAsureMeNt
Sociodemographic Characteristics
Educational performance and attainment
Employment
Characteristics of employment
Employment stability
Compensation
Attitudes and satisfaction
Perceived barriers to securing employment
Income

Legal vs. illegal source

Allocation of resources

Public assistance status

Other financial assistance

(e.g., benefits, resources)
Residential stability and living situation

Type of residence

Homelessness

Marital status

Acculturation (Hispanic participants)


Psychiatric Disorders
Psychotic disorders
Psychosis
Schizophrenia
Affective disorders

Gambling disorder

Substance use disorders
Alcohol abuse and dependence disorder
Marijuana use and dependence disorder
Other drug use and dependence disorders

Substance Use
Type of substance
Recency of use
Mode of use
Use during pregnancy
Context of use
Inhibition
Habitual use
Readiness for change

Criminal Activity
Onset
Type
Frequency
Recency
Context
Relationship to victim
Working alone or with others

Major depressive disorder

Arrest history

Dysthymic disorder

Access to and use of guns

Mania
Hypomania
Suicidality
Anxiety disorders
Separation anxiety disorder
Overanxious disorder
Generalized anxiety disorder

Incarceration History
Stays in correctional facilities
Age at incarceration(s)
Length of stay
Type of facility
Reentry from incarceration

Panic disorder

Number of release(s) into the community

Posttraumatic stress disorder

Resources at release

Attentional/disruptive behavioral disorders

Living arrangement after release

Attention-deficit/hyperactivity disorder

Employment after release

Oppositional defiant disorder

Relationship with community corrections
(e.g., parole, probation)

Conduct disorder

8

Antisocial personality disorder


Juvenile Justice Bulletin

Health and Impairment
Functional impairment
Global impairment
Domain-specific impairment
Physical functioning
Infection, disease
Injury
Chronic pain
Sexually transmitted infections
Sex risk behaviors
Drug risk behaviors
Global health and exercise
Cognitive functioning
Intellectual functioning
(composite IQ, verbal, nonverbal)
Academic achievement
(reading, arithmetic)
Quality of life
Mortality

Life Events
Milestones

Future orientation
Attitudes toward deviance and risky behavior

Service Utilization
Mental health and substance use services
Provider
Level of care
Community-based services

Inpatient services

Correctional services

Characteristics of services

Satisfaction with services

Payment for services

Perceived barriers to mental health
and substance use services
Physical healthcare utilization

Interpersonal and Community Characteristics
Family of origin characteristics
Household composition
Biological parental contact
Parental monitoring and disciplinary practices

Marriage

Primary caretaker(s) during childhood

Childbirth

Caretaker risk factors

Educational attainment

Substance use


Employment

Psychiatric problems


Adverse life events
Childhood maltreatment

Physical abuse

Sexual abuse

Neglect

Loss of intimates
Trauma and exposure to violence

Criminal involvement

Marital and intimate relationships
Quality of relationship
Behaviors and employment of partner
Parenting practices and attitudes
Social support
Deviant and peer associations


Victimization

Peer criminal activity


Sexual


Peer substance use


Domestic


Gang involvement


Criminal


Gang pressure toward deviance


Attitudes and Beliefs
Self-esteem

Structure and function of social support network

Sense of “mattering” to other(s)

Neighborhood characteristics

Self-efficacy

Neighborhood safety

Religiosity

Ease of obtaining drugs
Perceived violence

Juvenile Justice Bulletin

9

provides information on both prevalence and severity of
these disorders. It builds on earlier versions of the CIDI
and DIS–IV (Kessler and Üstün, 2004).

overview of selected findings
from NJP

NJP continues to use sections of the DIS–IV to assess
(1) antisocial personality disorder because it is not in­
cluded in WMH–CIDI 2000, (2) substance use disorders
because the WMH–CIDI collapses many types of drugs
into an “other” categor y rather than identifying specific
drugs abused, and (3) schizophrenia because the WMH–
CIDI screens for psychosis only.

Published data from NJP have been cited in the Report of the
Surgeon General’s Conference on Children’s Mental Health
(U.S. Department of Health and Human Services, 2000), by
national advocacy groups, and in reports to Congress. Analy­
ses of data from NJP are ongoing. To date, articles have
been published in the Archives of General Psychiatry, Ameri­
can Journal of Public Health, Journal of Adolescent Health,
Journal of the American Academy of Child and Adolescent
Psychiatry, Journal of Consulting and Clinical Psychology,
Pediatrics, and Psychiatric Services. A brief summar y of some
key findings follows (also see the sidebar, “Overview of Se­
lected Findings From the Northwestern Juvenile Project”).

Other Measures
More information about the measures used to assess other
variables listed in the sidebar on pages 8–9 will be pro­
vided in subsequent bulletins.

overview of seLeCteD fiNDiNGs froM the
NorthwesterN JuveNiLe ProJeCt
Characteristics of Youth in Detention

trauma and Posttraumatic stress Disorder

Prevalence of Psychiatric Disorders

•	 Ninety-three percent of participants had been exposed to
one or more traumas prior to baseline.

•	 Psychiatric disorders are prevalent: 66 percent of males
and 74 percent of females met the criteria for at least one
disorder at the baseline interview in detention.

•	 Significantly more males than females reported at least one
trauma.

•	 Substance use disorders are the most common: 51 percent
of males and 47 percent of females met diagnostic criteria
at baseline.

•	 Eleven percent of the sample met diagnostic criteria for
posttraumatic stress disorder (PTSD) in the past year; more
than half of participants with PTSD reported witnessing
violence as the precipitating trauma.

•	 Rates of many disorders were greater among females and
non-Hispanic whites.
Multiple Disorders
•	 Having more than one disorder is common: 46 percent of
males and 57 percent of females had two or more disor­
ders at baseline.
•	 Compared with participants who did not have a major men­
tal disorder (MMD), those with an MMD had significantly
greater odds of also having a substance use disorder.
•	 Multiple substance use disorders are also common: Among
participants with an alcohol disorder, four out of five also
had one or more drug disorders.
Prevalence of Psychiatric Disorders Among Youth
Processed as Adults
•	 Rates of psychiatric disorder among youth processed
in adult criminal courts are similar to the rates for youth
processed in juvenile courts: 66 percent had at least one
psychiatric disorder and 43 percent had two or more psy­
chiatric disorders.

10

Juvenile Justice Bulletin

•	 Among participants with PTSD, 93 percent also met
diagnostic criteria for at least one comorbid psychiatric
disorder.
suicidality
•	 More than one in three juvenile detainees (and nearly half of
female detainees) had felt hopeless or thought about death
in the 6 months prior to detention.
•	 One in ten juvenile detainees reported thinking about
committing suicide in the past 6 months; 1 in 10 had ever
attempted suicide.
•	 Recent suicide attempts were most common in females
and in youth with major depression and generalized anxiety
disorder.
•	 Less than 50 percent of detainees with recent thoughts of
suicide had told anyone about their ideation.
Child Maltreatment
•	 Four out of five juvenile detainees reported ever having
been physically abused.

Characteristics of Youth in Detention
This section discusses characteristics of the youth who
were sampled at detention.
Prevalence of psychiatric disorders. Psychiatric disorders
are prevalent among juvenile detainees; in NJP, almost
three-quarters of females and two-thirds of males in de­
tention had one or more psychiatric disorders. The rates
of disorder remained high even after excluding conduct
disorder. Substance use disorders, the most common type
of disorder, affected more than 50 percent of males and
47 percent of females (Teplin et al., 2002, 2006). Overall,
females were significantly more likely than males to have
a psychiatric disorder. Non-Hispanic whites were also

•	 Official records underestimate the prevalence of childhood
maltreatment; only 17 percent of participants who reported
any physical abuse, 22 percent who reported the great­
est level of abuse, and 25 percent who required medical
attention as a result of abuse had a court record for this
maltreatment.
Prevalence of hiv/AiDs risk behaviors
•	 Ninety-five percent of the sample engaged in 3 or more
HIV/AIDS risk behaviors; 65 percent engaged in 10 or more
risk behaviors.
•	 Participants with substance use disorders were more likely
to engage in HIV/AIDS risk behaviors.
•	 HIV/AIDS risk behaviors are persistent: More than twothirds of youth who engaged in 10 or more risk behaviors
at baseline persisted with at least 10 risk behaviors 3 years
later.

significantly more likely than African Americans or Hispan­
ics to have any disorder.
Multiple disorders. Many youth have more than one dis­
order; 57 percent of females and 46 percent of males met
diagnostic criteria for two or more disorders at baseline.
Detained youth were more likely to have substance use
disorders comorbid with attention-deficit/hyperactivity
disorder or other behavioral disorders than any other com­
bination of disorders. Participants with a major psychi­
atric disorder (e.g., major depression, mania, psychosis)
were significantly more likely to also have a substance use
disorder than were those without major psychiatric dis­
orders (Abram et al., 2003; Teplin et al., 2006). Multiple
substance use disorders are also common; more than 21

•	 The likelihood of detection and treatment was greater
among youth with a current major psychiatric disorder
or a history of receiving treatment, or among youth who
reported suicidality.
•	 The likelihood of detection and treatment was lower among
racial/ethnic minorities, males, older detainees, and youth
transferred to adult court.
functional impairment
•	 Twenty-two percent of youth had marked global impair­
ment that required intensive interventions from multiple
sources of care.
•	 Only 8 percent of the sample had no noteworthy
impairment.
Development of Antisocial Personality Disorder

Perceived barriers to Accessing Mental health services

•	 Three years after the baseline interview, 17 percent of de­
tained youth had developed antisocial personality disorder
(APD).

•	 Eighty-five percent of youth with psychiatric disorders re­
ported at least one perceived barrier to accessing services.

•	 Significantly more males than females developed APD.

•	 The most common barriers were the belief that the problem
would go away or could be solved on its own, uncertainty
about the appropriate place to get help, and difficulty ob­
taining help.

Outcomes of Juvenile Delinquents
Detecting and treating Psychiatric Disorders
•	 Among detainees with major psychiatric disorders and
functional impairment, 15 percent received treatment in
the detention center and 8 percent received treatment in
the community by the time of case disposition or 6 months
after detention.

Mortality
•	 The overall mortality rate of juvenile detainees an average
of 7.1 years after they were detained was more than four
times as large as the rate in the general population.
•	 The mortality rate of female detainees was nearly eight
times the rate in the general population.
•	 Ninety-six percent of deaths were homicides or legal
interventions (e.g., the youth was killed by police); among
homicides, 93 percent resulted from gunshot wounds.

Juvenile Justice Bulletin

11

disorder. Fewer than half of detainees with recent thoughts
of suicide had told anyone about their ideation (Abram,
Choe et al., 2008).
percent of participants had two or more substance use
disorders. The most prevalent combination of substance
use disorders was alcohol and marijuana. Among partici­
pants with an alcohol disorder, four out of five detainees
also had one or more drug use disorders (McClelland et
al., 2004).
Prevalence of psychiatric disorders among youth pro­
cessed as adults. Youth processed in adult criminal court
had rates of psychiatric disorder similar to those among
youth processed in juvenile court; 66 percent of youth
processed in criminal court had at least one psychiatric dis­
order and 43 percent had two or more types of disorder.
Among youth transferred to criminal court, those sen­
tenced to prison had significantly greater odds of having a
disruptive behavior disorder, a substance use disorder, or
comorbid affective and anxiety disorders (Washburn et al.,
2008).

Child maltreatment. Child maltreatment is common
among detained youth; 83 percent of detainees reported
physical abuse received from parents, stepparents, foster
parents, or other caretakers. Despite the high rates of selfreported physical abuse, a small proportion of all incidents
of maltreatment come to the attention of authorities: Only
17 percent of those who reported any type of physical
abuse, 22 percent of those who reported the most se­
vere level of physical abuse, and 25 percent of those who
reported needing medical attention as a result of physical
abuse had a court record of abuse or neglect (Swahn et al.,
2006).

Trauma and PTSD. Exposure to trauma is common
among juvenile detainees; nearly all of the NJP participants
(93 percent) experienced one or more traumas in their
lifetime at baseline. Significantly more males than females
reported having experienced a traumatic event (Abram et
al., 2004). More than 1 in 10 detainees met diagnostic
criteria for PTSD during the year prior to the baseline in­
ter view. Of those participants who met these criteria, more
than half reported witnessing violence as the precipitating
trauma. Among participants with PTSD, 93 percent also
met criteria for at least one comorbid psychiatric disorder
(Abram et al., 2007).

Prevalence of HIV/AIDS risk behaviors. Risk for HIV/
AIDS infection is high among detained youth, regard­
less of gender, race/ethnicity, or age. Approximately 95
percent of detained youth engaged in 3 or more HIV/
AIDS risk behaviors, and 65 percent engaged in 10 or
more HIV/AIDS risk behaviors. Significantly more
African Americans than non-Hispanic whites engaged
in sexual risk behaviors, while significantly more nonHispanic whites than African Americans engaged in drug
risk behaviors (Teplin et al., 2003). Detained youth with
substance use disorders, either with or without comorbid
major psychiatric disorders, were more likely to engage in
HIV/AIDS risk behaviors (Teplin, Elkington et al., 2005).
Youth continue to engage in HIV/AIDS risk behaviors
over time; more than two-thirds of youth who engaged
in at least 10 risk behaviors at their baseline interviews
persisted in at least 10 risk behaviors 3 years later (Romero
et al., 2007).

Suicidality. More than one-third of juvenile detainees felt
hopeless or thought about death in the 6 months before
detention. Approximately 1 in 10 juvenile detainees (10.3
percent) reported thinking about committing suicide in
the past 6 months, and 11 percent had attempted suicide
at some point in their lives. Recent suicide attempts were
most prevalent among females and among youth who
experienced major depression and generalized anxiety

Perceived barriers to accessing mental health services.
Approximately 85 percent of detained youth with psy­
chiatric disorders reported at least one perceived barrier
to accessing ser vices. The most common barrier was the
belief that problems would go away without help or that
the individual could solve problems independently. Youth
also reported that they were unsure of where or how to
obtain help and that help was too difficult to obtain. Many

12

Juvenile Justice Bulletin

“Three years after detention, African American and Hispanic
males living in the community were more likely to be
impaired than non-Hispanic whites and females.”

participants denied having a problem; detained youth who
do not recognize their mental health needs or who feel
that they can resolve their problems alone are unlikely to
seek ser vices or cooperate with services when they receive
them (Abram, Paskar et al., 2008).

Key Outcomes of Study Participants
This section presents some of the outcomes of the youth
who participated in NJP.
Detecting and treating psychiatric disorders. Among
detainees who had major psychiatric disorders and associ­
ated functional impairments, records showed that only 15
percent had been treated in the detention center before
release and that even fewer (8 percent) had been treated
in the community during the 6 months following their
interview in detention (Teplin, Abram et al., 2005). The
likelihood that disorders would be detected or treated was
greater among youth who had a current major psychiatric
disorder, a history of receiving treatment, or who reported
suicidality at intake, whereas the likelihood was lower
among racial/ethnic minorities, males, older detainees,
and detainees transferred to adult court for legal process­
ing (Teplin, Abram et al., 2005).
Functional impairment. Three years after detention,
most participants continue to struggle in one or more
major life domains; more than one in five participants had
markedly impaired functioning that required intensive
intervention. These youth failed to meet age-appropriate
social, occupational, and interpersonal indicators. Only 8
percent of the entire sample demonstrated no noteworthy
impairment (Abram et al., 2009).
Development of antisocial personality disorder. Nearly
one-fi fth (17 percent) of male juvenile detainees devel­
oped antisocial personality disorder (APD) approximately
3 years after detention. Significantly more males than
females developed APD, but no differences were found by
race/ethnicity. A diagnosis of conduct disorder (CD) and
the number of CD symptoms endorsed were significantly
associated with developing modified APD (M–APD; i.e.,
APD without the CD requirement). Subsequent analyses,

however, indicated that the number of CD symptoms
affects risk for M–APD: Participants with five or more
CD symptoms were significantly more likely to develop
M–APD than those with fewer than five symptoms.
Analyses also indicated that several other disorders were
significantly associated with developing M–APD, including
dysthymia, alcohol use disorder, and generalized anxiety
disorder (Washburn et al., 2007).
Mortality. Based on the total number of deaths of 15- to
24-year-old participants that occurred an average of 7.1
years after baseline, standardized mortality rates among ju­
venile delinquents were more than four times greater than
rates in the general population. Mortality among females
was nearly eight times greater than in the general popula­
tion. For both males and females, all deaths resulted from
external causes; 96 percent of the deaths were the result of
homicide or legal inter vention (e.g., the study participant
was killed by police). Gunshot wounds were the primary
means of death (93 percent of the homicides) (Teplin,
McClelland et al., 2005).

summary
As the first large-scale, prospective longitudinal study of
drug, alcohol, and psychiatric disorders in juvenile detain­
ees, the Northwestern Juvenile Project provides muchneeded insight into the types of services and treatment
that youth in the juvenile justice system most require.
Findings from the study have been published in peerreviewed journals, cited in the Surgeon General’s Report
on Children’s Mental Health and in reports to Congress,
and used by national advocacy groups.
The findings presented in this and future bulletins will
help build the empirical foundation on which practition­
ers will develop and implement appropriate ser vices to
facilitate youth’s successful reentry into the community.
Analyses and data collection are ongoing.

Juvenile Justice Bulletin

13

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Juvenile Justice Bulletin

15

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Acknowledgments
Linda A. Teplin, Ph.D., is the Owen L. Coon Professor and Vice Chair for Research in the
Department of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine, Northwestern University, Chicago, IL, as well as Director of the Department’s Program in Health
Disparities and Public Policy.
Karen M. Abram, Ph.D., is Associate Professor and Associate Director, Health Disparities and
Public Policy, in the Department of Psychiatry and Behavioral Sciences at the Feinberg School of
Medicine.
Jason J. Washburn, Ph.D., ABPP, is Assistant Professor and Director of Education and Clinical
Training in the Division of Psychology, Department of Psychiatry and Behavioral Sciences at the
Feinberg School of Medicine. He is also Director of the Center for Evidence-Based Practice at
Alexian Brothers Behavioral Health Hospital, Hoffman Estates, IL.
Leah J. Welty, Ph.D., is Assistant Professor in the Department of Preventive Medicine and the
Department of Psychiatry and Behavioral Sciences at the Feinberg School of Medicine. She is also
a biostatistician in the Biostatistics Collaboration Center at the Feinberg School of Medicine.
Jennifer A. Hershfield, M.A., is a doctoral candidate in the Division of Psychology, Department of
Psychiatry and Behavioral Sciences at the Feinberg School of Medicine.
Mina K. Dulcan, M.D., is a Professor in both the Department of Psychiatry and Behavioral Sciences and the Department of Pediatrics at the Feinberg School of Medicine. She is also the Head
of the Department of Child and Adolescent Psychiatry at the Ann & Robert H. Lurie Children’s
Hospital of Chicago.
The authors thank all of their agencies for their collaborative spirit and steadfast support. They
also thank the research participants for their time and willingness to participate as well as the
Cook County Juvenile Temporary Detention Center, Cook County Department of Corrections,
and Illinois Department of Corrections for their cooperation.

The research described in this bulletin
was supported in part by grants 1999–JE–
FX–1001, 2005–JL–FX–0288, and 2008–JF–
FX–0068 from the Office of Juvenile Justice
and Delinquency Prevention (OJJDP), U.S.
Department of Justice.
Points of view or opinions expressed in
this document are those of the authors
and do not necessarily represent the official
position or policies of OJJDP or the U.S.
Department of Justice.

The Office of Juvenile Justice and Delinquency Prevention is a component of the
Office of Justice Programs, which also includes the Bureau of Justice Assistance; the
Bureau of Justice Statistics; the National
Institute of Justice; the Office for Victims
of Crime; and the Office of Sex Offender
Sentencing, Monitoring, Apprehending,
Registering, and Tracking.

NCJ 234522

 

 

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