1. Mental Health Service Needs and Service Use of Juvenile Detainees Karen Abram, Ph.D. Psycho-Legal Studies Program Northwestern University Feinberg School of Medicine, 710 N. Lake Shore Drive, Suite 900, Chicago, IL 60611 k-abram@northwestern.edu Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

2. Northwestern Juvenile Project Goals: To determine how alcohol, drug and mental disorders develop over time among delinquent youth. To investigate whether delinquent youth receive needed services in detention and the community. Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

3. Participants Hispanic (n=524) Non-Hispanic White (n=296) African American (n=1005) Male (n=1172) Female (n=657) Juvenile Court (n=1554) Adult Court (n=275) % Age Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

4. Psychiatric Disorder Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

5. Prevalence of Psychiatric Disorder % * * * 0 10 20 30 40 50 60 70 80 Any DisorderAffectiveAnxietyDisruptive Behavior Substance Use Male Female Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

6. Males Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

7. Females Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

8. Comorbid Types of Disorder Among Males 16.4% 14.6% 3.2% 2.1% 6.9% 1.6% 1.4% 1.2% 1.1% 1.0% 0.7% 6.7% 2.0% 2.1% 4.3% Affective 17.9% Substance 49.8% Anxiety 21.1% ADHD/ Behavioral 41.7% None of the Listed Disorders 34.8% Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

9. 4.8% 1.2% 2.2% 2.3% 2.0% 2.9% 6.0% 9.6% 4.9% 3.9% Substance 44.5% 6.7% 7.6% 14.0% 2.6% Anxiety 31.5% Affective 26.4% None of the Listed Disorders 27.2% ADHD/ Behavioral 46.3% Comorbid Types of Disorder Among Females Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

10. Adverse Life Events Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

11. History of Trauma Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author. %

12. History of Intimate Loss % Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

13. Childhood Maltreatment % Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

14. Service Needs Summary Mental and substance use disorders are prevalent among juvenile detainees Substantial sex differences in mental health need Substance use disorders are most prevalent disorders Substantial comorbidity Prevalence of adverse life events impacts treatment needs Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

15. Service Utilization Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

16. Need for Mental Health Services Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author. Major Mental Disorder Other Disorders No Disorder

17. Among juvenile detainees who needed treatment, what proportion received it? (n=303) Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

18. Among juvenile detainees who needed treatment, who were more likely to receive it: Females or Males? Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

19. Among juvenile detainees who needed treatment, who were more likely to receive it: African Americans, Hispanics, or Whites? Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

20. Among juvenile detainees who needed treatment, who were more likely to receive it: Males or Females? (n=302) Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

21. Among juvenile detainees who needed treatment, who were more likely to receive it: Younger or Older? Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

22. Percent of Youth with Substance Use Disorders at Follow-Up Who Received Substance Use Services Since Their Last Interview (past three years) Any Service 13 % 87 % Northwestern Juvenile Project Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

23. Services Summary More than 4/5 of detainees who need treatment do not receive it. Disparities are the rule, not the exception. Those least likely to receive services are: –Male –Older, and –African American Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

24. Development of Disorders Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

25. Prevalence of Disorder at Baseline & Follow-up: Males % Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

26. Prevalence of Disorder at Baseline & Follow-up: Females % Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

27. What Disorders Persisted? % Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

28. What Disorders Developed? % Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

29. Mortality Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

30. List of 74 Deceased Participants Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

31. Causes of Death in Delinquent Youth, Weighted Percentages* Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

32. Detained PopulationGeneral Population Standardized Mortality due to External Causes (per 100,000 person- years) in Delinquent and Community Youth 0 200 400 600 800 Annual Deaths per 100 000 person-years Total AAWHTotal AAWH Male Female 83.5 Crude U.S. Mortality Ages 15-24 * 806 184 847 887 435 228 60 807 283 36 233 42 315 22 501 18 195 83 Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.

33. Conclusions Mental and Substance Use Disorders are prevalent at baseline & follow-up Substantial gender differences in the prevalence and course of disorders Substance Use Disorders persist and develop Need for treatment extends into adulthood Abram (2006). Prison Health Research Network, Manchester. Please do not cite or distribute without permission from author.