18.1 Diagnoses and Treatment After Juvenile Justice Mental Health Service Evaluation

Abstract

The aim of this poster is to compare diagnoses and medications prescribed in secure juvenile detention before and after evaluation by a trauma-informed mental health service. Participants included all consecutive admissions to New York City secure juvenile detention facilities between September 17, 2015 and October 30, 2016 (N = 1638). A total of 322 participants were referred to a facility-based mental health service for diagnostic evaluation and medication treatment as indicated. Prior historical diagnoses and medication usage were abstracted from history gathered during the evaluation and any other available records. Following evaluation, there were significantly higher rates of diagnoses for disruptive behavioral (73.3% vs 17.1%; p < 0.001), substance-related (52.8% vs 4.7%; p < 0.001), trauma-related (46.3% vs 3.1%; p < 0.001), and depressive (14.3% vs 8.1%; p = 0.008) disorders. There were significantly lower rates for bipolar disorders and non–DSM-5 diagnoses. Prescription rates after evaluation were significantly less for antipsychotics (8.7% vs 35.1%; p < 0.001), psychostimulants (24.5% vs 38.2%; p < 0.001), and mood stabilizers (2.2% vs 9.6%; p < 0.001), and significantly more for sleep aids (14.9% vs 6.2%; p < 0.001). These data are among the first to compare diagnoses and treatment following detention-based treatment with those received prior to admission to juvenile detention. The results highlight the high and inappropriate use of antipsychotics and mood stabilizers. They also show higher rates of trauma-related, depressive, and disruptive behavioral diagnoses following evaluation that support the need for trauma-informed and nonpharmacological treatment in detention. The higher rates of substance-related diagnoses following evaluation underscores the need for substance use treatment programs within juvenile detention.