This study examined the frequency and nature of violence directed at staff in a state inpatient psychiatric hospital for children and adolescents.A total of 215 assaults that occurred over a two-month period were examined by using information obtained from staff at the time of the assault and from the hospital database. Assaults were analyzed for situational characteristics of the incidents as well as the characteristics that best differentiated between assaultive and nonassaultive patients.Thirty-three percent of all hospitalized patients were involved in an assaultive incident. A majority of the patients who assaulted staff were neither involved in the juvenile justice system nor psychotic. Although youths who were involved in repeat assaults were more likely to be male, gender did not differentiate between those who were assaultive toward staff and those who were not. Some type of verbal direction or redirection (typically minor) on the part of the staff preceded a majority (68 percent) of the assaults.Preconceived notions about why youths assault staff at psychiatric hospitals do not appear to be validated by these data, which suggest a more complex picture.
This study examines the competence-related abilities of 120 psychiatrically hospitalized male juveniles age 10 to 17 years, using the MacArthur Competence Assessment Tool-Criminal Adjudication (MacCAT-CA), the Brief Psychiatric Rating Scale-Anchored (BPRS-A), the Massachusetts Youth Screening Instrument (MAYSI), the Kaufman Brief Intelligence Test (K-BIT), and discharge diagnoses derived from file review. The findings indicate significant age-related differences across adolescence with a relatively strong performance for most of the youths on the competence measure. While intellectual and psychiatric factors were found to contribute substantially to deficits in legal decisional ability, they were modulated by age and the developmental factors associated with it. These findings, replete with caveats concerning both the dimensional structure of competence as measured by the MacCAT-CA and the interplay with the mental status and developmental factors affecting it, underscore the multifarious nature of legal decisional capacity in youths of varying ages. The relevance of these findings to the structuring of restoration services and the application of legal theory to the competence standard in juvenile court are discussed.
Our study examines the experiences of 563 youth ordered into restoration services after a judicial finding of adjudicative incompetence. Among this group, 72% were determined to be restored to competence usually within 90 to 120 days of services provided in the least restrictive environment allowed by the courts. These outcomes were achieved using an individualized psycho-educational intervention that combined intensive case management, developmentally informed interactive educational tools, and case integration and mentoring by specially trained restoration counselors. These individualized services were provided to each youth on average three times a week by the restoration counselor contracted to provide services in the location where the youth was residing. No juveniles were admitted for inpatient hospitalization for the purpose of restoration only. Five percent were hospitalized based upon civil commitment criteria or for further psychiatric evaluation or stabilization. Chi-square Automated Interaction Detector (CHAID) analyses were used to create decision trees of the restoration pathways demonstrated by four subgroups of youth: Mental Illness Only (MIO), Mental Retardation Only (MRO), Mental Illness and Mental Retardation (MI-MR), and No Mental Illness and No Mental Retardation (NMI-NMR). The interaction of individual characteristics and interventions varied across the four groups with the highest rates of restoration being achieved by youth in the NMI-NMR group (91%) and the lowest rate among youth in the MRO group (47%). These rates of restoration are comparable to those achieved using residential treatment for youth and inpatient hospitalization for adults.
This article provides an overview of what is known about the prevalence, diagnosis, and effective treatment of mood disorders among youths, particularly among juvenile offenders, and discusses the unique problems that arise for the delivery of treatment services. The relationship between mood disorders and disruptive or delinquent behaviors as well as the particular importance of proper diagnosis and treatment of mood disorders in this population are discussed.A search was conducted of the MEDLINE and PsycINFO databases for articles that had been published since 1980 on mood disorders in the juvenile offender population as well as articles on adolescent mood disorders.The studies on the prevalence of mood disorders among juvenile offenders varied significantly in the methodology used and in the rates of prevalence found, although all studies showed that this population had high rates of mood disorders. The identification and effective treatment of mood disorders is critical because these disorders are a leading cause of suicide among adolescents and because mood disorders may contribute to or exacerbate delinquent and disruptive behaviors.Juvenile detainees have a constitutional right to needed mental health treatment. More comprehensive mental health services are required to ensure that juvenile offenders with mental illness are identified and cared for appropriately. Doing so not only will alleviate painful symptoms but may also contribute significantly to improvements in psychosocial functioning, interpersonal relations, and school performance and to decreases in delinquent, disruptive, and suicidal behaviors.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)