Mapping the social service pathways of youth to and through the juvenile justice system: A comprehensive review

Children and Youth Services Review 30 (2008) 1376–1385

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Children and Youth Services Review j o u r n a l h o m e p a g e : w w w. e l s ev i e r. c o m / l o c a t e / c h i l d yo u t h

Mapping the social service pathways of youth to and through the juvenile justice system: A comprehensive review Tina Maschi a,⁎, Schnavia Smith Hatcher b, Craig S. Schwalbe c, Nancy Scotto Rosato d a b c d

Fordham University Graduate School of Social Service, 113 West 60th Street, New York, New York 10023, United States University of Georgia School of Social Work, 302 Tucker Hall, Athens, Georgia 30602, United States Columbia University School of Social Work, 1255 Amsterdam Ave., New York, New York 10027, United States Rutgers University, Institute for Health, Healthcare, and Aging Research, 30 College Avenue, New Brunswick, New Jersey 08904, United States

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Article history: Received 11 October 2007 Received in revised form 29 December 2007 Accepted 15 April 2008 Available online 23 April 2008 Keywords: Youth Service utilization Social services Juvenile justice Literature review

a b s t r a c t The purpose of this review was to detail the human or social service needs and service use patterns (i.e., healthcare, education, social services, child welfare, mental health, and substance abuse) that influence youth's entry and prolonged involvement with the juvenile justice system. What emerged from the literature was a pattern of service needs and prior service usage that placed youth at risk of juvenile justice involvement. Extralegal factors, such as individual characteristics (e.g., race/ethnicity, gender, and mental health and trauma histories) and social/environmental characteristics (e.g., family conflict, unmet service needs, and prior social service use) influenced how youth traveled across the sectors of care. The authors present a social justice systems model that depicts the varied service pathways that youth may concurrently or sequentially travel across the social and justice systems of care. The paper concludes with a discussion of the implications for practice, policy, and research. © 2008 Elsevier Ltd. All rights reserved.

1. Introduction On any given night, a sizable number of youth are cycled through the juvenile justice system for varying lengths of stay. In 2003, law enforcement officials made 2.2 million juvenile arrests. Of those youth arrested, over one-half (n = 1.6 million) of them moved forward to be processed by the court for mostly nonviolent (57%, n = 108,700) followed by violent offenses (43%, n = 92,300). The majority of these adjudicated youth received judicial dispositions that resulted in out of home residential treatment (n = 92,000) or secure care juvenile justice settings (n = 66,000) (Snyder & Sickmund, 2006). The literature suggests that youth's entry, exit, and prolonged involvement in the juvenile justice system are influenced by a host of individual and social/environmental factors beyond purely legal factors. Individual characteristics, such as race/ethnicity, gender, and psychosocial histories of mental health, substance abuse, trauma, and delinquency have been shown to increase the risk that youth will encounter the juvenile justice system (Dembo, 1996; Grisso, 1999; Wasserman, Larkin, & McReynolds, 2004). Similarly, social/environmental risk factors, such as family conflict, geographic location, poverty, and prior human or social services utilization, may also influence youth's entry and prolonged visitation in this most restrictive service care sector (GAO, 2003). Youth characteristics (e.g., race/ethnicity, gender, and age) may influence juvenile justice system involvement. Research has shown that African American and Hispanic youth compared to their Caucasian counterparts receive more severe dispositions at each stage of the juvenile justice system, even when controlling for similar crimes (Youth Law Center, 2000). Adolescent male youth also are at an elevated risk. Official statistics reveal that male youth between the ages of 16 and 17, are at significant risk of receiving an official delinquency disposition (Snyder & Sickmund, 2006).

⁎ Corresponding author. E-mail addresses: [email protected] (T. Maschi), [email protected] (S.S. Hatcher), [email protected] (C.S. Schwalbe), [email protected] (N.S. Rosato). 0190-7409/$ – see front matter © 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.childyouth.2008.04.006

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Youth with mental health histories also are at risk of being disproportionately diverted to a juvenile justice destination. Studies have shown that upwards of 50% of youth within correctional facilities also carry with them a history of a diagnosable mental health disorder and/or prior inpatient or outpatient mental health treatment (Otto, Greenstein, Johnson, & Friedman, 1992; Teplin, Abram, McClelland, Washburn, & Pikus, 2005). Official statistics show 11% of detained youth with mental health problems (and no delinquent offense) may be placed in detention for varying lengths of stay while awaiting community treatment. The warehousing of youth with mental health problems for treatment in the juvenile justice system has led one administrator to call the juvenile detention center a “depository of last resort“(GAO, 2003, p. 8). While we have a general understanding of the risk factors for youth's involvement in individual sectors of care, we have yet to assemble a panoramic portrait of the multiple service needs and service utilization patterns of youth. Therefore, the purpose of this review is to document the service needs and service use trajectories of youth across the various human, social, and justice sectors of care. These services include: healthcare, education, social services, child welfare, mental health, substance abuse, and juvenile justice. The two research questions that guided this review were as follows: (1) What are the service needs and service use patterns among youth across the social and juvenile justice sectors of care (i.e., health, education, social services, child welfare, mental health, substance abuse, and juvenile justice)? (2) What are the contributing factors that influence youth's service trajectories (i.e., entry, exit, and prolonged involvement) in the juvenile justice system? Gaining a broader understanding of the factors that influence youth's juvenile justice involvement has important implications for practice and policy. In an era of shrinking resources, mapping the ‘cycle of services’ among youth and their families can provide opportunities for streamlining services and develop new avenues for collaboration among the different sectors of care. This information can be used to develop and/or improve system wide policies, evidence-based practices, and research designed to meet the needs of youth, families, and communities as well as reduce societal costs. 2. Literature review Since children represent a vulnerable population, various social and justice institutional networks have been developed to help ensure their safety, needs, and rights. These institutional networks include: the family and community and specialized subsystems within the community that include healthcare, education, social services, child welfare, mental health, substance abuse, and juvenile justice. While some services, such as healthcare and education, are universal for all citizens, other services, such as the child welfare, mental health, substance abuse, and the juvenile justice sectors of care, specifically target at-risk youth and their families (Garland, Hough, Landsverk, & Brown, 2001; USPHS, 1999, 2000). Evidence suggests that youth who encounter the juvenile justice system have a history of concurrent and/or sequential service needs and prior human service involvement. What follows is a narrative description of the divergent and convergent pathways of human service needs and service usage patterns of youth that encounter the juvenile justice system. The following human services and justice sectors of care are reviewed in the following order: healthcare, education, child welfare, mental health, substance abuse, and the juvenile justice subsystems. 2.1. Healthcare The pathway between healthcare and juvenile justice appears fraught with obstacles for some youth. It is common for youth in the juvenile justice system to have had a prior lack of access to healthcare services. This service obstacle is problematic since healthcare is a universal need, especially for youth, to develop and maintain their health and well-being or obtain assistance for medical emergencies (Garland et al., 2001). Unfortunately, universal access to quality services is a goal that is far from achieved. In 2003, 10.1% of US children were without healthcare (Cohen & Coriaty-Nelson, 2004). Unequal access is especially common among minority and low income youth whose needs far outweigh their access to health care services (Golzari, Hunt, & Anoshiravani, 2006). Overall, the literature suggests that many youth who enter the juvenile justice system often lack consistent community health care prior to and after placement in the juvenile justice system. In fact, for many youth, the juvenile justice system provided them their first access to needed health care services (Golzari et al., 2006; Pumariega et al., 1999; Rogers, Pumariega, Atkins, & Cuffe, 2006). 2.2. Education The literature shows a relationship between school problems and juvenile justice involvement among youth. This pathway exists for youth in mainstream as well as special education services. They will be reviewed in that order, respectively. 2.2.1. Mainstream education Similar to the health care sector of care, education is a primary service in which all youth are expected to participate. The purpose of elementary and secondary education is to facilitate the development of youth's capacity to be successful and productive members of society (Garland et al., 2001). However, school problems (e.g., learning disabilities, mental health issues, course failure, grade failure, school suspensions, and dropping out) increase the risk of juvenile justice involvement among youth (Bruns, Moore, Stephan, Pruitt, & Weist, 2005; Kaufman, Alt, & Chapman, 2004; Kutash & Duchnowski, 2004; Malmgren & Meisel, 2002). The majority of youth at-risk, especially for dropping out of high school, are Hispanic or African American males, between the ages of 15 and 18, from low income families (Kaufman et al.; Laird, Lew, DeBell, & Chapman, 2006).

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2.2.2. Special education services Research suggests that there is a high prevalence of youth with special education needs in the juvenile justice system. This link is especially pronounced for youth with serious emotional disturbance (SED), which is a mental, behavioral or emotional disorder that often results in functional impairment in several domains, such as family, school or community activities (Malmgren & Meisel, 2002). Malmgren and Meisel (2002) found that youth with SED also had a history of other psychosocial issues such as delinquency, substance abuse, abuse history, school problems and prior placement in special education programs in a general education school. Thus, youth with SED (which represent about 5% of the school population) pose a significant challenge for the educational system to coordinate concurrent educational services with other service systems, such as health, mental health, child welfare, and the juvenile justice systems (Hansen, Litzelman, Marsh, & Milspaw, 2004; USPHS, 1999, 2000). 2.3. Social services Prior research shows a link between social service needs and juvenile justice involvement. While social services are our “nation's system of programs, benefits, and services that help people meet those social, economic, educational, and health needs that are fundamental to the maintenance of society,” official statistics reveal that many of our nation's children and their families fall short of this goal (Zastrow, 2004, p. 5). In 2002, 11 million children in the United States lived in poverty (U.S. Census Bureau, 2002), 1.35 million of the children were homeless, (National Coalition for the Homeless, 2007) and almost 1 million children had special health care needs (NCHS, 2001). Research suggests that unmet social service needs place youth at risk for juvenile justice involvement. Risk factors, such as low socioeconomic status, disability status, runaway status and/or homelessness, significantly increase the risk of juvenile justice involvement (USDHHS, 2006). For example, some youth who run away (which is a status offense) may become homeless because their home environment is unsafe, especially due to family violence (Hyde, 2005). Subsequently, these youth are at an elevated risk for more serious crimes, such as theft, in an attempt to survive on the streets (Hyde, 2005). In contrast, obtaining needed social services may act as a defacto gatekeeper for other needed human services. Farmer et al. (2003) found that youth who were involved in social services were more likely to receive mental health services compared to children in poverty who had no social service involvement. These findings suggest that assessment and service referrals that address the psychosocial treatment needs of youth may provide a pathway to services that may reduce their risk of juvenile justice involvement. 2.4. Child welfare 2.4.1. Service overview Evidence suggests that another pathway exists between the child welfare and juvenile justice systems. This link is paradoxical since the child welfare system was designed to promote the well-being and safety of children (Laird & Hartman, 1986). Youth who enter the child welfare system often do so because their personal safety is alleged to be at risk, particularly if they are alleged victims of child abuse and/or neglect. The core services provided to address their high risk situation include: child protective services (CPS) and the juvenile and family courts. Additional treatment or placement services may include in or out of home placement including family preservation services, family reunification, foster care, adoption, guardianship, and independent living (Badeau & Gesiriech, 2003). Research reveals that individual and social/environmental risk factors place youth at heightened risk for entry and prolonged involvement in this system, which is outlined next. 2.4.2. Individual risk factors Individual risk factors, such as type of victimization, have been found to influence youth's entry and service use patterns in the child welfare system (USDHHS, 2006). Official statistics demonstrate that youth who enter the child welfare system for child maltreatment do so more often for acts of omission (i.e., neglect) than for acts of commission (i.e., physical or sexual abuse). Of the 872,000 youth with substantiated reports of abuse, the majority (62.4%) of them were for neglect, followed by sexual abuse (17.5%), physical abuse (7.5%), psychological maltreatment (7%), and medical neglect (2.1%) (USDHHS, 2006). Other individual risk factors, such as age, gender, race/ethnicity, and disability status, influence child welfare involvement. Young children (i.e., ages 1 to 11) are more likely to come to the attention of child welfare services for abuse and neglect. While girls (51.7%) and boys (48.3%) enter the child welfare system of about equal proportions, girls are more likely to have been victims of sexual abuse while boys are more likely to have been victims of physical abuse (USDHHS, 2006). Minority youth (i.e., African American, American Indian, Hispanic, and Asian/Pacific Islanders) and youth with disabilities are at a higher risk of child welfare involvement. In 2004, minority youth were overwhelmingly (87.3%) the substantiated victims of child maltreatment compared to Caucasian (10.3%) youth (USDHHS, 2006). Similarly, reports of child maltreatment are more likely to be substantiated for youth with disabilities (USDHHS, 2006). 2.4.3. Social/environmental risk factors Social and environmental risk factors, such as family characteristics, have been linked to child welfare involvement. National statistics reveal that the majority (83.4%) of the perpetrators are the youth's parents (USDHHS, 2006). Youth involved in the child welfare system are more likely to live in female headed households, receive social service benefits, live below the poverty level, and

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have large family sizes (USDHHS, 2006). Additionally, parents who are younger, of African American background, or who have substance abuse problems are more likely to come to the attention of child welfare service (Burns et al., 2004; McDaniel & Slack, 2005). Psychosocial histories of mothers have been shown to increase their children's risk of child welfare involvement. Mothers with prior foster care placement, sexual abuse, and running away from home as an adolescent are risk factors for their children's child welfare involvement (Ethier, Couture, & Lacharité, 2004). More recent stressful life events (i.e., moving to a new home, having a baby, being arrested, or having a child who is suspended or expelled from school, and living in an impoverished or crime ridden neighborhood) also increase the risk of being investigated by child welfare services (Burns et al., 2004; McDaniel & Slack, 2005). Systemic problems, such as institutionalized bias and racism, lack of accessibility to services, and service gaps, may also influence service use patterns among youth and their families in child welfare. Evidence suggests that racial/gender bias may influence professional decision-making processes from allegation to official disposition of an abusive or neglectful parent (Leigh, 1986; Wright & Thomas, 2003). The lack of accessible human services may also trigger child welfare involvement. According to the GAO (2003), families may be misdirected into the child welfare system because they lack private and public health insurance or the community has limited available services in mental health agencies or schools. Gaps in service coordination between child welfare and other sectors of care can impact the duration of stay in the system (Armstrong, 1998; USDHHS, 2006). 2.4.4. The child welfare-juvenile justice connection Over four decades of research has shown a link between child welfare and juvenile justice involvement (Benda & Corwyn, 2002; Jonson-Reid, 1998; Kapp, 2000; Smith & Thornberry, 1995). The lack of services following substantiated abuse has been found to be a risk factor for juvenile justice involvement, especially for minority youth (Jonson-Reid, 2004). Jonson-Reid (2004) found when minority youth were provided no services after a Child Protective Services (CPS) investigation, they were more likely to become involved in the juvenile justice system. The gender and age of youth with substantiated cases of child maltreatment has been found to influence juvenile justice involvement. Studies have shown that males compared to females with substantiated cases of child maltreatment are more likely to become involved in the juvenile and criminal justice systems (Kapp; 2000; Zingraff, Leiter, Myers, & Johnsen, 1993). However, Jonson-Reid and Barth (2000) found that girls with a history of foster care placement were at an elevated risk of future juvenile justice involvement. Youth first removed from their home between the ages of 12 and 14 for sexual abuse and neglect were at an increased risk of juvenile justice involvement (Jonson-Reid, 2004). Foster care is another risk factor (Jonson-Reid & Barth, 2000). Jonson-Reid and Barth found that instability in child welfare foster care placed youth at an increased risk of placement in foster care supervised by the probation department. Youth with mental health needs may also have these needs unmet or inadequately treated while in child welfare placement (Armstrong, 1998; Shin, 2002; USDHHS, 2006). Many of the youth with histories of substantiated childhood victimization and mental health problems were found to later reside under the care of the juvenile justice system (USDHHS, 2006). 2.5. Mental health and substance abuse Research suggests a relationship among mental health, substance abuse, and juvenile justice involvement. Mental health and substance abuse services for youth are designed to enhance socioemotional functioning and psychological well-being. Depending on the severity of the problem, mental health and substance abuse services vary from community outpatient services to out of home inpatient or rehabilitation services. These services may be voluntary or court mandated, which may include involuntary commitment (USPHS, 1999). 2.5.1. Mental health Evidence suggests that youth with mental health and substance abuse problems are more commonly found among the juvenile justice population compared to the general population. The Mental Health Report of the Surgeon General revealed that about 20% of children within the community were estimated to have mental disorders with at least mild functional impairment (USPHS, 1999, 2000). This percentage has been found to be two to three times higher among juvenile justice populations (Otto et al., 1992; Teplin et al., 2005). Studies have shown that between 50 and 75% of incarcerated youth nationwide have diagnosable mental health disorders (Huber & Wolfson, 2000; Otto et al., 1992). A juvenile's mental health status may very well be a factor in juvenile justice placement. For example, in 2004, a governmental report found that over half of the 524 detention facilities surveyed reported that they were holding youth because of the community's lack of mental health treatment for them. The detention administrators reported that these juveniles were sentenced by the court for secure care placement because there were no alternative placements for the youth other than in the juvenile justice system (GAO, 2003). The juvenile justice system, however, is not necessarily equipped to serve youth with mental health needs and as a result provides little to no mental health care compared to other service sectors such as the education setting (Farmer, Burns, Phillips, Angold, & Costello, 2003). The prevalence of youth with mental health problems in the juvenile justice system may also be a consequence of policy reform spearheaded by the deinstitutionalization movement. The deinstitutionalization movement originated in the 1950s and advocated for the community placement of individuals residing in more restrictive institutional settings. Thus, deinstitutionalization became the impetus for the downsizing and closing of many state mental hospitals across the United States. Additional public policy

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changes eventually led to the closing of many community treatment facilities impacting youth and adult populations (Lamb & Weinberger, 1998). The rapid increase of individuals with mental illness in adult jails and prisons since deinstitutionalization has also occurred in the juvenile justice system (Huber & Wolfson, 2000). 2.5.2. Substance abuse Research has shown a link between substance abuse and juvenile justice involvement. Between one-quarter to one-half (25% to 50%) of juvenile detainees report a history of substance use and abuse (Abrantes, Hoffman, & Anton, 2005; Dembo, 1996). Substance use also is a contributing factor at the time of a youth's arrest. A large percentage (between 40% and 69%) of juvenile arrestees had an illegal drug detected in their urine at the time of arrest (NIJ, 1999). Youth placed in secure care settings often have unmet prior substance abuse service needs. Abrantes et al. (2005) found that 150 out of their sample of 252 youth in the detention center met the substance use dependence criteria, with the average time of use being 4.56 years. These juveniles also reported an average of 2.5 years from when they began using substances to then getting into legal trouble. The comorbidity of mental health and substance abuse issues is common among juvenile justice populations. Abrantes et al. (2005) found that the overwhelming majority (90%) of the study participants had possible diagnoses of major depressive disorders, mania, conduct disorders, and substance dependence. Conduct disorder and substance dependence were the most frequently reported co-occurring disorders. Prior mental and substance abuse treatment may act as a risk factor for juvenile justice involvement. Lyons, Baerger, Quigley, Erlich, and Griffin (2001) found that youth with histories of prior treatment services, both in mental health and substance abuse treatment, were related to incarceration. 2.6. Juvenile justice The juvenile justice system is designed as the system of last resort, specifically to address unlawful behavior among youth. Youth may travel divergent service pathways to the juvenile justice system that involves no prior service usage to sequential or concurrent service usage across multiple sectors of care. Some youth may have unmet service needs (e.g., health, mental health, and substance abuse) and travel directly from the community to the juvenile justice system. Other youth may travel to the juvenile justice system with a history of single system use, such as child welfare, or concurrent or sequential service use, such as wraparound services. Legal and extralegal factors influence whether youth are diverted from or funneled more deeply into the juvenile justice system. These decision-making points comprise a continuum ranging from police discretion to arrest, court intake and prosecution, detention and jail/lockup placement, adjudication and conviction, judge's disposition sentencing for community versus out of home placements, and parole and aftercare service treatment and monitoring (Bartollas & Miller, 2005; Snyder & Sickmund, 2006). Regardless of their origin, once youth enter any stage of the juvenile justice system, the treatment philosophy and strategies differ from other human service sectors of care. The juvenile justice system has three major objectives: to protect public safety, to hold juvenile offenders accountable for their behavior, and to provide treatment and rehabilitation services for juveniles and their families (Bartollas & Miller, 2005, Snyder & Sickmund, 2006). This system's approach is to combine opposing intervention strategies of punishment and rehabilitation interventions that are geared towards deterring youth from engaging in juvenile offending behaviors (Bartollas & Miller, 2005). 2.6.1. Individual factors Individual characteristics, such as gender, age, and race/ethnicity influence how youth travel across the juvenile justice system. Official statistics reveal that the majority of juveniles arrested are male (68%), between the ages of 16 and 17 (68%), and are disproportionately African American (27%) (Snyder & Sickmund, 2006). Minority youth, in particular, are at an elevated risk of juvenile justice involvement across all critical decision-making points from initial police contact to court referral and dispositions and subsequent placement in secure care settings (Bilchik, 1999). A host of extralegal issues influence a youth's involvement in the juvenile justice system. Youth with mental health problems, especially conduct disorder and oppositional defiant disorder, substance abuse problems, school problems, trauma histories, and antisocial behavior are common among juvenile justice populations. Legal factors that predict more severe dispositions of secure care out of home placement include: severity of current charges, previous convictions, prior misdemeanors, probation violations, and previous dispositions (Abram et al., 2004; Bruns et al., 2005; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002; Teplin et al., 2005, 2005; O'Neill, 2002). 2.6.2. Social/environmental factors Environmental factors, especially the lack of available services, also place youth at risk for juvenile justice involvement. Research has shown that parents may place their children in the juvenile justice system because they lack health coverage or the community lacks appropriate community services (GAO, 2003). State officials and service providers may provide parents with misguided information to place their child in the juvenile justice system in order to receive ‘treatment’ (Koppelman, 2005). Moreover, the lack of coordination among the different service providers before, during, and after juvenile justice involvement also significantly decreases the effectiveness of rehabilitative efforts, especially for youth with complex needs that involve prolonged involvement with multiple sectors of care (Garland et al., 2001).

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Prior social service use among youth also has been shown to be a contributing factor for more severe court dispositions. Contributing factors, such as prior mental health and substance abuse service histories, child welfare involvement, prior residential placements, and predisposition detention, increase the likelihood that youth will receive a court disposition for out of home placement (Lyons et al., 2001; O'Neill, 2002; Rogers et al., 2006). Attorney representation is a contributing factor that impacts the length of juvenile justice involvement. That is, the type of attorney representation (i.e., no attorney, public defender, or private attorney) has been shown to influence whether youth are diverted to the community or given out of home secure care placement. Guevara, Spohn, and Herz (2004) found that the presence of an attorney, especially a private attorney, may exacerbate the situation, especially for minority youth. That is, minority youth who used a private attorney were least likely to have their charges dismissed and more likely to receive a disposition for secure confinement. The recent growth of stricter public policies towards juvenile offenders places youth at risk for prolonged juvenile justice involvement, especially if youth are waivered from juvenile to adult court. Kurlychek and Johnson (2004) found when juveniles are waived to adult court they are sentenced more severely in adult courts than the adult offenders with similar offenses. 2.6.3. Disparities in access to services within the juvenile justice system Studies have consistently shown a high prevalence of health, educational, mental health, and substance abuse needs in the juvenile justice system, especially among youth placed in confined settings (e.g., Teplin et al., 2002; Vermeiron, 2003; Wasserman et al., 2004). For some youth, incarceration might be the first time that they have access to ongoing health care, education, and substance abuse and mental health services (Golzari et al., 2006; Rogers et al., 2006). However, once placed in a secure care setting, disparities in obtaining these services remain, especially for minority youth. Rawal, Romansky, Jenuwine, and Lyons (2004) found that African American youth had the greatest level of needs and were more likely to have their mental health needs underserved. Rogers et al. (2006) found that incarcerated Caucasian youth were more likely to be referred for services than African American youth. These findings suggest that youth, especially minority youth, even when placed in the juvenile justice system may go undetected and untreated for mental health and other psychosocial issues. 2.6.4. The juvenile justice to community reentry pathway The literature also suggests protective factors that reduce prolonged involvement with the juvenile justice system. Characteristics of adjudicated adolescents in residential care treatment programs have been shown to increase youth's community and residential program retention, successful reentry efforts, and reduced recidivism rates. Youth's ‘pretreatment’ characteristics, such as level of substance abuse severity and motivation to change, and program factors (e.g., level of safety and level of service utilization) have been shown to influence whether youth successfully completed their program (Orlando, Chan, & Morral, 2003). Recidivism rates among adjudicated adolescents in residential care may be reduced by ongoing family contact, such as inhome counseling, campus visits initiated by family members, and home visits initiated by family service workers (Ryan & Yang, 2005). Once youth are paroled (i.e., conditionally released back to the community) from residential or secure care placement, several factors influence whether youth exit or are recycled through the juvenile justice system. Contributing social/environment factors, such as access to services and other community resources have been shown to have a positive influence on the transition of youth from incarceration back to school, work, and the community (Baltodano, Mathur, & Rutherford, 2005; Golzari et al., 2006). Baltodano et al. found that youth with personal and interpersonal resources (i.e., effective communication skills, access to caring individuals, and adult mentoring and support) greatly increased their successful reintegration into the community and their eventual exit from the juvenile justice sector of care. In contrast, youth who lacked awareness of the aftercare process upon release, linkages to services (including education and health care), educational problems, and the lack of positive peer and adult influences were more likely to reenter the juvenile justice system. Youth connected with Wraparound Services that involve families and providers in coordinating juvenile justice, mental health, and other services and supports, were also less likely to recidivate (Pullman et al., 2006). 2.7. Conceptual models Several conceptual models have been put forth that stress the interrelationships among the different sectors of care (i.e., healthcare, education, social services, child welfare, mental health, substance abuse, and juvenile justice) outlined in this review (Bazemore & Terry, 1997; Finkelhor, Cross, & Cantor, 2005; Garland et al., 2001; Howell, Kelly, Palmer, & Mangum, 2004; Nissen, Merrigan, & Kraft, 2005; Staller, 2004). Proponents of systems of care models are in general agreement that the traditional fragmented sectors of care models are not effective. The literature review suggests that youth continue to hit roadblocks that prevent them from gaining effective treatment across system service points. The current crisis in care has been attributed to the lack of coordination of services, lack of integration among service systems, lack of community support for success, lack of effective services, and the use of hierarchical leadership structure (Bazemore & Terry, 1997; Finkelhor et al., 2005; Garland et al., 2001; Howell et al., 2004; Nissen et al.; 2005; Staller, 2004). Youth with Serious Emotional Disorders (SED), in particular, pose a significant challenge for service providers because of their complex needs. Since many SED youth exhibit multiple problems, many researchers and scholars have recommended a coordinated response across the sectors of care that includes juvenile justice, education, child welfare, primary health care, mental health, and substance abuse systems of care (Garland et al., 2001; Hanson, Litzelman, Marsh, & Milspaw, 2004). The Systems of Care Model has been defined as a “comprehensive spectrum of mental health and other necessary services which are organized into a

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coordinated network to meet the multiple and changing needs of severely emotionally disturbed children and adolescents” (Garland et al, 2001, p. 127). Services, such as wraparound services and multisystemic therapy, are found to be effective for these populations at given points in time. However, Garland et al. argued that cross-sectional interventions, such as wraparound services, do not have the long term effects needed to help youth with long-term multiple problems. This short-term approach, in turn, places youth at risk for juvenile justice involvement. In order to address this concern, Garland et al. (2001) have proposed a dynamic ‘systems of care model’ that moves beyond static ‘cross-sectional’ models, such as ‘wraparound’ services. Rather than addressing only multiple concurrent time-limited service and/or long term involvement with one system, their model tracks youth's concurrent and sequential service involvement over time. Other important recommendations for system reform found in the literature include system integration, collaboration, information sharing, and the adoption of a collaborative leadership model that involves all key stakeholders in decision-making (Bazemore & Terry, 1997; Finkelhor et al., 2005; Garland et al., 2001; Howell et al., 2004; Nissen et al., 2005; Staller, 2004). 3. Summary and conclusion The purpose of this review was to document the service needs and service use patterns of youth who travel the juvenile justice system. The major sectors of care: healthcare, education, social services, child welfare, mental health, substance abuse, and juvenile justice were reviewed. Conceptual models that address youth with multiple concurrent or sequential service needs were presented. What emerged from this review was a pattern of individual and social/environmental factors that placed youth at an elevated risk for juvenile justice involvement. As illustrated in Fig. 1, individual risk factors that influenced youth's entry and prolonged involvement in the juvenile justice system included minority versus majority status, socioeconomic status, gender, and a history of trauma, mental health, or substance abuse problems. Social/environmental risk factors, such as unmet service needs and/or prior service involvement with special education services, child welfare, social services, and mental health and/or substance abuse treatment, influenced youth's entry and prolonged service use patterns across multiple systems of care. More specifically, the following patterns were uncovered. First, youth may have multiple service needs that may go undetected (e.g., health care needs), despite their participation in other sectors of care (e.g., education). Second, vulnerable youth populations, such as minority and low income youth, are not provided equal access to high quality health care services and education while they are disproportionately involved in high risk services, such as the child welfare and juvenile justice systems. Third, youth in the juvenile justice system bring with them varying histories of psychosocial problems and service use patterns. What results is that many youth that encounter the juvenile justice system bring with them a complex array of service needs that require unique

Fig. 1. An illustration of the impact of individual and social/environmental contributing factors that influence youth's entry, exit, and length of involvement in concurrent and/or sequential service usage.

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Fig. 2. A social-justice systems model: a diagram of the different services youth may travel across the social and justice system of care.

interventions. Fourth, successful efforts that enhanced prosocial youth development included the involvement of youth, their families and communities, the availability of specialized services, and multi-systemic coordinated care responses. Based on the findings of the review, these authors have developed a conceptual model that depicts the ‘cycle of services’ that youth may concurrently and/or sequentially utilize. As shown in Fig. 2, the ‘social justice’ system is comprised of a youth's proximal social system, such as the family, in which youth's primary socioemotional development needs are addressed. In a functional situation, a youth's involvement in the system would include interactions with family and other social networks as well as with the universal services of health and education. The treatment oriented services may be needed when there is a breakdown in individual and/or social environmental factors (e.g., youth mental health problems, allegation of child maltreatment, parental loss of employment, and delinquency) that increase the need for involvement in service subsystems, such as child welfare, mental health, substance abuse, and juvenile justice systems. The permeable circle illustrates that youth and their family may use services concurrently or sequentially. Services may vary on a continuum from the least restrictive (e.g., community services) to most restrictive service environments (e.g., inpatient mental health or substance abuse treatment or juvenile justice secure care placement). Legal and extralegal contributing factors are shown to influence youth's entry and length of service involvement. In essence, what we are promoting via this model is a ‘children's rights to services’ perspective. As illustrated, youth and their families as well as the individual sectors of care are embedded within a community context. This bird's eye view of the whole system minimizes the potential for service providers to assume a ‘system-centric’ approach to assessment and treatment of youth that may miss all service needs. This holistic view also makes it clear that the development and improvement of services should include all system stakeholders, including youth and their families, professionals from across the sectors of care, and community members. The findings of this review have important implications for practice and policy. Additional community efforts should be made to determine the multiple needs of all youth. In particular, if educational settings assumed a more holistic approach to youths' rights and needs, this system in turn can assume a more coordinating role in identifying the physical and mental health needs of youth and the coordination of referrals or services. Another important area of intervention is providing additional diversity training of school, community, and court personnel, including clinicians, judges, police and probation officers, and client advocates, to minimize the influence of extralegal factors as a risk factor for youth's juvenile justice involvement. Human services professionals, especially social workers, are in an ideal position to help pave or repave the service pathways so that vulnerable youth can receive services within the community rather than in the juvenile justice system. Human services workers trained in generalist and systems frameworks makes them particularly adept at developing and/or administering multi

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service coordination. Professionals applying a multisystemic model would need to be trained and proficient in service coordination, interdisciplinary collaboration, policy advocacy, and practice and program evaluation. Future directions for research also are warranted. Additional research is needed that investigates the service needs and service utilization patterns of youth as well as the effectiveness of individual or multiple service interventions. In particular, the use of longitudinal mixed methods designs that track youth across the social and justice systems of care would help advance our knowledge in this area. These research findings can then be applied to design or improve existing service responses for vulnerable youth and their families. 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