August 2004J. Robert Flores, Administrator

U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

Access OJJDP publications online at www.ojp.usdoj.gov/ojjdp

with inadequate psychometrics, the failureto consider comorbidity (i.e., co-occurringconditions), problems with identifyingsample characteristics, and a lack of infor-mation regarding when the assessmentswere conducted. They note that previousstudies often did not define the timeframefor symptoms. However, distinguishingbetween lifetime and current symptomsis important not only for determining theprevalence of disorders but also in plan-ning for immediate service needs.

Although great advances have been madein reliable mental health assessment ofchildren and adolescents (Jensen et al.,1995; Shaffer et al., 1996), assessment prac-tices in juvenile justice settings remainhighly variable and generally have notused evidence-based, scientifically soundinstruments (Cocozza and Skowyra, 2000;LeBlanc, 1998; Nicol et al., 2000; Towber-man, 1992; Wiebush et al., 1995). A com-mon practice has been to rely on a youth’shistory of using mental health services asan indicator of whether the youth current-ly needs services. However, researchsuggests that the juvenile justice systemcannot rely on other systems to provideinformation on the previous use of mentalhealth services for all youth at entry. Forexample, Novins and colleagues (1999)

Assessing the Mental HealthStatus of Youth in JuvenileJustice Settings

Gail A. Wasserman, Susan J. Ko, and Larkin S. McReynolds

Youth in the juvenile justice system are athigh risk for mental health problems thatmay have contributed to their criminalbehavior and that are likely to interferewith rehabilitation (Loeber et al., 1998;Lynam, 1996). Emotional impairment dueto an untreated mental disorder may con-tribute to an adverse reaction to confine-ment, which in turn may result in a pooradjustment during incarceration. Pooradjustment can have a negative impacton behavior, discipline, and on a youth’sability to participate in available programcomponents designed to address mentalhealth, emotional, physical, and academicneeds. Together, all of these factors mayincrease the risk for recidivism.

In a review of 34 studies on mental healthneeds and services in the juvenile justicesystem, Otto and colleagues (1992) foundthat rates of mental disorders were sub-stantially higher among youth involved inthe justice system than among youth inthe general population. They also foundthat rates of disorder were higher in stud-ies that assessed youth in person than inthose that assessed youth by chart review.These authors suggested that existing stud-ies of the prevalence of mental disordersamong youth in the juvenile justice systemwere limited by the use of instruments

A Message From OJJDPSerious mental health and substanceuse disorders can interfere with therehabilitation of youth who come intocontact with the juvenile justice sys-tem and increase their risk for recidi-vism. Too often, the needs of theseyouth have gone unrecognized anduntreated because of inadequatescreening and assessment.

One obstacle to assessing the mentalhealth needs of youth in the juvenilejustice system has been the dearthof reliable, easy-to-use assessmentinstruments. This Bulletin reports theresults of a study of the VoiceDISC–IV, a version of the DiagnosticInterview Schedule for Children(DISC) that is self-administered usinga computer and headphones. TheDISC is an extensively tested childand adolescent diagnostic interviewthat has been evaluated in clinicaland community settings. The self-administered Voice DISC offers sev-eral advantages for use within thejuvenile justice system—notably,minimal staff support requirements,immediate scoring that generatesprovisional DSM–IV diagnoses, andthe assurance of privacy that can en-hance the willingness of youth to dis-close sensitive personal information.

Based on their findings and those ofother researchers, the authors recom-mend best practices in assessing themental health of juvenile offenders.This Bulletin provides guidance tojuvenile justice professionals seekingto establish guidelines for mentalhealth assessment in juvenile justicefacilities.

O f f i c e o f J u s t i c e P r o g r a m s • P a r t n e r s h i p s f o r S a f e r C o m m u n i t i e s • w w w. o j p . u s d o j . g o v

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third edition revised (DSM–III–R), and ofthe World Health Organization’s Interna-tional Statistical Classification of Diseasesand Related Health Problems, 10th revision(ICD–10). The DISC–IV provides a detailedassessment of impairment based on re-sponses to six sets of questions aboutthe effect of symptoms on the youth’srelationships with his or her caretakers,family, or peers and at school.3

The psychometrics of the DISC have beenevaluated extensively in a variety of set-tings. Five studies of psychiatric disor-ders in youth in various juvenile justicesettings have reported rates based onsystematic assessment using the DISC (Atkins, Pumariega, and Rogers, 1999;Duclos et al., 1998; Garland et al., 2001;Randall et al., 1999; and Teplin et al.,2002). Except for the study by Garlandand colleagues, all of these investigationswere based on earlier, now superseded,versions of the DISC, and none used therecently developed Voice DISC, which isself-administered using a computer andheadphones. Several aspects of the VoiceDISC make it well suited for use withinthe juvenile justice system:

◆ Minimal staff support requirements.

◆ Immediate scoring, with a printoutof provisional DSM–IV diagnoses andsymptom counts available for followupby a clinician.

◆ Increased likelihood of disclosure,especially for suicidality and substanceuse. (The enhanced privacy of the self-administered format contributesto the willingness of youth to disclosesensitive personal information.)

Preliminary data show that the reliabilityof the Voice DISC is comparable to that ofother versions of the DISC (Lucas, 2003).

In contrast to many other assessmentinstruments, the Voice DISC provides pro-visional diagnoses for the youth assessed.Because diagnosis drives mental healthtreatment, having information about ayouth’s diagnosis is critical. Most evidence-based treatment services have been de-signed for specific disorders and havebeen shown to be effective only whenthey are provided to youth who havethose disorders. The Voice DISC generatesprovisional diagnoses of disorders presentin the past month, which makes it espe-cially useful within juvenile justice settings,where prompt identification of youth whoneed immediate treatment is important.

found that only 34 percent of a sampleof juvenile detainees with a documentedanxiety, affective (mood), or disruptivebehavior disorder had previously receivedservices for those disorders. Similarly,the Policy Design Team (1994) found thatapproximately 50 percent of the juveniledetainees in Virginia showed mentalhealth problems of moderate severityor higher and that 8.5 percent showed“severe” problems, but that only 15 per-cent of the detainees who exhibited men-tal health problems were receiving mentalhealth services while in custody. A studyof youth in South Carolina found thatdespite higher rates of disorder, incarcer-ated youth were significantly less likelyto have received outpatient mental healthservices previously than were youthenrolled in a community mental healthservice (Pumariega et al., 1999). Otherresearch suggests that minority youthand youth of low socioeconomic statusare less likely to have a history of usingmental health services (Pumariega et al.,1998).1

This Bulletin reports the results of astudy that used a computerized, self-administered version of the DiagnosticInterview Schedule for Children (DISC) toscreen for psychiatric disorders in youthnewly admitted to juvenile assessmentcenters in Illinois and New Jersey. Thestudy assessed rates of psychiatric disor-ders and tested the feasibility of using thisassessment instrument among youth inthe juvenile justice system.2 Recommenda-tions are also offered for “best practices”for mental health assessment in juvenilejustice settings based on a comparison ofthe rates of psychiatric disorder identifiedin this study with those found in otherstudies in which earlier versions of theDISC were used in juvenile justice settings.

Diagnostic InterviewSchedule for ChildrenThe Diagnostic Interview Schedule forChildren (DISC) is an extensively testedchild and adolescent diagnostic interviewthat has been evaluated in both clinicaland community samples (Shaffer et al.,1996). A family of highly structured psy-chiatric interviews designed to assessmore than 25 different mental disordersin children and adolescents, the DISCincorporates the diagnostic criteria ofthe American Psychiatric Association’sDiagnostic and Statistical Manual of MentalDisorders, fourth edition (DSM–IV) and

Study MethodThe executive director of the Councilof Juvenile Correctional Administrators(CJCA) helped to solicit collaborationfrom juvenile facilities by announcing thestudy at the Council’s 1998 annual confer-ence. The directors of the Illinois Depart-ment of Corrections, Juvenile Division,and the New Jersey Juvenile Justice Com-mission provided access to the St. CharlesReception Center in Illinois and the NewJersey Training School for Boys. The studyprovided training, technical assistance,assessment materials, and funding for reim-bursement of staff time. Local staff agreedto collect assessments for 100 randomlyselected male youth in Illinois and 200 inNew Jersey.

Altogether, 320 youth were asked to par-ticipate; of these, all but 5 agreed. Twelveassessments were not included for techni-cal and logistical reasons. Seven parentswithdrew their child’s data. Data wereavailable, then, for 296 youth (94 in Illinoisand 202 in New Jersey), reflecting a re-sponse rate of more than 92 percent foryouth approached in both sites.4

For all youth who agreed to participate,the data collector briefly demonstratedthe operation of the computer programand made sure the youth was comfortableproceeding independently after the firstmodule, which gathers demographic data.The data collectors remained available ata distance (to ensure privacy) throughoutthe assessment.

Background information (age, race/ethnicity, school grade, admission date,number of prior offenses, and currentoffense) was abstracted from receptioncenter files in each location. Because ayouth could have more than one currentoffense, up to four current offenses wereprovided from justice records for eachyouth.

ResultsThe average participant in the study was17 years old and in the 9th grade (i.e., 2years behind the expected grade), andmore than half (53.7 percent) of the youthwere African American (tables 1 and 2).Eighty-eight percent of the youth wereassessed within 4 weeks of their admis-sion to the facility, with 40 percent beingassessed within 2 weeks of admission.Most of the youth had previous contactwith the juvenile justice system; 28 percenthad committed one or more substance-related offenses.

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the sample were examined: youth whomet criteria for a substance use disorderonly (n = 68), those who met criteria for adisorder other than substance use (n = 53),and those with no evidence of a disorder(n = 97).5 Sixty-five of these 218 youth wereincarcerated for a substance use offense:28 who had only a substance use disorder,10 who had a disorder other than sub-stance use, and 27 who had no diagnoseddisorder. Of these 65 youth, those with asubstance use disorder were significantlymore likely to have been incarcerated fora substance-related offense than the youthin either of the other two groups (see thefigure on page 4).

Discussion

Prevalence of PsychiatricDisorder in Justice SystemYouthArriving at a DSM diagnosis requiresconsideration of the extent of a youth’simpairment (i.e., deficits in functioning)across a number of different domains.Because the DISC uses the logic of theDSM–IV, it also provides an impairmentscore. For several reasons, the findingspresented in this Bulletin are based ondiagnostic criteria only and do not con-sider the level of impairment.6

The assessment inquired about 20 psychi-atric disorders and took an average of 60minutes to complete. As would be expect-ed, the youth in whom more disorderswere diagnosed needed more time to com-plete the assessment. Unsolicited, fiveyouth commented that they felt safer dis-closing information to the computer thanto a person.

Table 3 presents the number of youth whomet the criteria for each disorder in thepreceding month. Because suicidality isof great concern for management in resi-dential programs, information on reportedsuicidal ideation and attempts is presentedin table 4.

Table 3 shows high current rates for manydisorders in the sample as a whole. Beyondthe expectably high numbers of youthmeeting criteria for substance use or con-duct disorders, the rates of current moodand anxiety disorders were also high (9.1percent and 18.9 percent, respectively). Inaddition, 9.1 percent of the youth report-ed suicidal ideation in the past month and2.7 percent reported having attempted tocommit suicide during the past month.

To examine the degree to which a VoiceDISC–IV diagnosis of a substance use dis-order corresponded to a record of sub-stance use offenses, three groups within

Table 1: Demographic and OffenseCharacteristics of theStudy Sample

Characteristic Mean SD

Age (years) 17.04 1.39Current school

grade 9.63 1.39Number of prior

convictions 4.7 4.4Number of days

since admission 18.7 12.6

Table 2: Race/Ethnicity of the StudySample

Race/Ethnicity Number Percent

African American 159 53.7White 81 27.4Hispanic 49 16.6Other 7 2.4

Note: Percents do not sum to 100 because ofrounding.

Table 3: Prevalence of Psychiatric Disorders Within the Past Month

Number of Youth Disorder (N = 296) Percent*

None 97 32.8

Any anxiety disorder† 56 18.9Anxiety disorder only 17 5.7Agoraphobia 13 4.4Generalized anxiety 6 2.0Obsessive-compulsive 13 4.5Panic 13 4.5Posttraumatic stress 13 4.5Social phobia 7 2.4Specific phobia 25 8.5

Any mood disorder 27 9.1Mood disorder only 1 0.3Manic episode 6 2.1Hypomanic episode 2 0.7Major depressive 21 7.2Dysthymic‡ 2 0.7

Any disruptive disorder 94 31.8Disruptive disorder only 21 7.1ADHD 6 2.3Conduct§ 89 31.7Oppositional defiant 8 2.8

Any substance use disorder 146 49.3Substance use disorder only 68 23.0Alcohol dependence 38 12.9Alcohol abuse 47 17.0Marijuana dependence 72 25.7Marijuana abuse 42 15.0Other substance dependence 36 12.8Other substance abuse 11 3.9

Note: Diagnoses are based on DSM–IV criteria only.

* The prevalence for some diagnoses is based on a slightly reduced number because some youthdid not complete the entire DISC interview (e.g., because they were transferred).

† Separation anxiety disorder either not assessed or not included.‡ Current DISC and DSM–IV criteria necessitate that youth with major depressive disorder do notalso receive a diagnosis of dysthymia.

§ Past 6 months.

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Although its assessment of disordercriteria is straightforward, the self-administered nature of the Voice DISCrelies on a youth’s awareness of the socialand personal consequences of his or herdisorder to determine impairment.Because the social judgment of youthfound guilty of delinquent or criminal be-havior may be particularly poor, the VoiceDISC may substantially underreport thelevel of impairment in these youth. A cli-nician considering impairment for thepurpose of making a diagnosis should relyon multiple informants and various piecesof information to determine the level ofimpairment.

Comparison With OtherStudiesAs shown in table 5, the rates of disorderfound in the present study are somewhat

lower than those reported by previousstudies that used the DISC in juvenilejustice populations. However, the earlierstudies used earlier versions of the DISC.Consideration of four basic differences ininstrumentation and sample characteris-tics between the present study and theprevious investigations puts the differ-ences in the results into context:

◆ Participants in the present study re-sponded to questions about the monthpreceding the interview, a period con-siderably shorter than the 6-monthreporting timeframe of most of theearlier studies. In some cases, the ratesof disorder found in the present studywere correspondingly somewhat lowerthan those found in the studies thatused a longer timeframe (Atkins,Pumariega, and Rogers, 1999; Ducloset al., 1998; Randall et al., 1999; Garlandet al., 2001; Teplin et al., 2002).

◆ The present study evaluated youthwho recently had been sent to secureplacement (likely after they had spentweeks in juvenile detention). The youthassessed by Teplin and colleagues(2002) were being held in detention—that is, they recently had been in thecommunity, where they had the oppor-tunity to offend. Garland and col-leagues (2001) assessed “wards of thecourt” without regard to whether theywere in the community or in custody.By intent, secure placement limits mis-behavior. The more structured andcontrolled the setting, the less opportu-nity youth have to engage in the behav-iors characteristic of conduct and sub-stance use disorders. Therefore, ratesfor those disorders might be expectedto be lower for the youth in the presentstudy than for the youth evaluated inthe earlier studies.

◆ The present study relied exclusively onself-report, whereas Garland and col-leagues (2001) pooled diagnostic infor-mation received from parents as well asyouth, a procedure that results in in-creased prevalence rates (Bird, Gould,and Staghezza-Jaramillo, 1992). Pa-rental informants are more likely thanyouth to report symptoms of disrup-tive behavior disorders such as atten-tion deficit/hyperactivity disorder(ADHD) and conduct disorder (Jensenet al., 1999), and this may account forthe variability in the reported rates ofdisorder across the studies.

◆ Because many youth entering securecare will recently have been removedfrom their homes, their endorsement ofseparation anxiety symptoms may notreflect enduring disorder. Therefore, incontrast to the earlier studies, the pres-ent investigation did not inquire aboutseparation anxiety disorder. This deci-sion may have caused the rates foroverall anxiety disorders observed inthe present study to be somewhatlower than those in the earlier studies.

The rate of suicide attempts in the pastmonth (2.7 percent) reported by youth inthe present study is comparable to therate of suicide attempts by youth in thepast month that was reported by facilitiesin the Conditions of Confinement study(2.5 percent) (Parent et al., 1994), lendingfurther support to the validity of the VoiceDISC assessment.

Although the prevalence of conduct disor-der in the study sample was high (31.7percent), the prevalence rates for other

Note: SUD, substance use disorder.

Perc

ent

Diagnostic Grouping

No disorder SUD only No SUD0

10

20

30

40

50

41.2

27.8

18.9

Percent of Youth Incarcerated for a Substance Use Offense Relative toDisorder Status as Diagnosed by the Voice DISC–IV

Table 4: Prevalence of Suicide Ideation or Attempt

Suicide Ideation Number of Youthor Attempt (N=296) Percent*

Ideation (past month) 27 9.1Attempt

Past month 8 2.7Lifetime 35 11.8

Note: Diagnoses are based on DSM–IV criteria only.

* The prevalence for some diagnoses is based on a slightly reduced number because some youth didnot complete the entire DISC interview (e.g., because they were transferred).

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disruptive behavior disorders—ADHD(2.3 percent) and oppositional defiantdisorder (2.8 percent)—were lower thanmight be anticipated. In clinical samples,as many as 75–90 percent of children withconduct disorder have also been found tohave ADHD (Abikoff and Klein, 1992). Otherstudies have reported a link between theimpulsivity of ADHD and delinquency(Mannuzza et al., 1993; Masse and Trem-blay, 1997; McGee, Williams, and Feehan,1992; Tremblay et al., 1994).

The rates of self-reported ADHD in otherstudies of juvenile justice populations thatused the DISC are similarly low—between1 and 7 percent (Atkins, Pumariega, andRogers, 1999; Randall et al., 1999; Teplinet al., 2002). In the study done by Garlandand colleagues (2001), who combinedinformation from parental and youthreports, almost 13 percent of the youthreceived a diagnosis of ADHD, but thisrate is still lower than expected. However,the rates of mood and anxiety disordersare high in the present study (9.1 percentand 18.9 percent, respectively) and acrossall five of the other DISC studies in juve-nile justice populations (10–35 percent).Zoccolillo (1992) noted a high rate ofcomorbidity between mood and anxietydisorders and conduct problems in com-munity samples of youth. Further, studiesthat used the DISC–2.3 to assess clinic-referred children found associations be-tween anxiety symptoms (“trait anxiety”)and both conduct problems and aggression

(Frick et al., 1999) and between mania andconduct disorder (Biederman et al., 1999).

Although a determination of juvenile delin-quency is not synonymous with a diagno-sis of a disruptive disorder, the results ofthe present study and the existing researchindicate systematic underreporting ofADHD symptoms by youth in the justicesystem. This suggests that self-reportedinformation should be supplemented byreports from another informant (e.g., aparent or teacher), especially as parents’reports are more consistent with otherindicators of conduct disorder, such asschool suspension and police contacts,than youth’s reports (Loeber et al., 1991).7

Recommendations forJuvenile Justice MentalHealth AssessmentThe findings of the present study shedlight on the prevalence of mental healthdisorders among youth in the juvenile jus-tice system. Consideration of the ways inwhich case identification is affected bythe assessment method used suggests thefollowing best practices for clinical assess-ment in different justice settings:8

◆ Mental health assessments should bebased on multiple methods of evalua-tion and on the input of multiple in-formants. A structured interview isone important component of a mentalhealth assessment. Other important

components include direct observa-tion, a mental status examination, chartreview, an interview with parent(s) orcaregiver(s), and obtaining a family psy-chiatric and psychosocial history.

◆ Assessments should be based onreliable and valid instruments. Useof a common assessment “language”eliminates uncertainty about the crite-ria used to determine diagnoses andenables comparison across studiesand facilities.

◆ Assessments should include parentalinput. Parental input is valuable indiagnosing certain disorders, particu-larly ADHD. Incorporating parentalreports into mental health assessmentsof youth in the justice system is com-plicated by several factors, includingparents’ unavailability or reluctance toincriminate their children. The accu-racy of parental reports may also belimited due to parent-child separation.However, when parental and youthreports of ADHD symptoms are com-bined, increased rates of this disorderare detected (Garland et al., 2001).

◆ Assessments should focus on recentsymptoms in order to determine cur-rent treatment needs. Depending onthe purpose of the assessment and thesetting in which it takes place, the time-frame for diagnostic status might varyfrom the past year to the past month.Assessments should be driven by

Table 5: Comparison of Rates of Mental Health Disorders Found in the Present Study With Those Found in EarlierStudies Using the DISC

NumberRate of Disorder (percent)

Question of YouthDISC Format and Study Timeframe Evaluated Disruptive Substance Mood Anxiety

Administered by interviewerDuclos et al. (1998)* Past 6 months 150 21 38† 10 7Atkins, Pumariega,

and Rogers (1999) Past 6 months 75 43 20 24 33Randall et al. (1999)‡ Past 6 months 118 45 NA 14 36Garland et al. (2001)* Past 6 months 478 48§ NA 7 9Teplin et al. (2002) Past 6 months 1,826 42 50 19 22

Self-report (Voice DISC)Present study Past month 296 32 49 9 19

Note: NA, not assessed.

* Study used impairment criteria in the determination of diagnostic status. That is, in addition to meeting diagnostic criteria, youth had to endorse a response to one of three impairment questions at the end of individual disorder modules to receive a diagnosis.

† Assessed on the Composite International Diagnostic Interview (Robins et al., 1988).‡ Aggregate data provided by the authors.§ Includes responses of both youth and parental informants.

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practical decisions that take intoconsideration needs at various stagesof justice system processing. For exam-ple, assessments might aim to accu-rately identify at least two groups ofyouth: (1) those whose mental healthneeds should be met quickly, such asyouth who recently have attemptedsuicide or who currently suffer from apanic disorder or substance depend-ence, and (2) those who need closesupervision and regular reassessment,such as youth with less severe disor-ders (e.g., depression or posttraumaticstress disorder) that may worsen underthe stress of confinement.

◆ Some youth should be reassessed peri-odically. Youth should be reassessedregularly when they are held in custodyover an extended period of time, assymptom profiles may shift. Mood dis-orders and anxiety disorders, in partic-ular, may wax and wane over time.

ConclusionsThe study reported in this Bulletin repre-sents the first investigation of the VoiceDISC–IV in juvenile justice settings. Theresults demonstrate that use of a system-atic instrument for assessing psychiatricdisorders is feasible in juvenile justice set-tings. The assessment was well toleratedby youth and their parents and by theagency/institution staff who were involvedin administration procedures. Two find-ings provide initial support for the validityof the Voice DISC–IV assessment:

◆ Youth who met the Voice DISC–IVcriteria for substance use diagnoseshad been incarcerated for substanceoffenses.

◆ The rate of suicide attempts in the pastmonth reported by youth in this studyis comparable to the rate of suicideattempts by youth in the past monthreported by facilities in the Conditionsof Confinement study.

Thus, this initial feasibility study demon-strates that a comprehensive, scientifical-ly sound diagnostic instrument can be avaluable part of mental health assessmentfor youth in the juvenile justice system.

For Further InformationMore information on the authors’ researchusing the Voice DISC–IV and on otherassessment-related research is availableonline at www.promotementalhealth.org,

the Web site of the Center for the Promo-tion of Mental Health in Juvenile Justice.

Endnotes1. The rate of mental health servicesreceived by youth in the juvenile justicesystem prior to detention has not beencompared with the rate of previous men-tal health services for youth in a similarpopulation (as opposed to the generalyouth population).

2. For a more comprehensive earlierreport, see Wasserman et al., 2002.

3. In addition to the self-report versionof the DISC for youth, a parent-reportversion is available. Some juvenile justicefacilities may find this useful when assess-ing a youth’s mental health.

4. The data reported here include datafor four youth who inadvertently werenot included in an earlier report of thisresearch by Wasserman and colleagues(2002). Inclusion of the additional datadoes not alter the findings.

5. Youth who had a substance use disor-der plus some other disorder (n = 78) werenot included in these analyses.

6. See Wasserman et al., 2002, for furtherdiscussion of this issue and for rates thattake impairment into account.

7. Although more research is needed, it islikely that youth also underreport ADHDsymptoms in other arenas, such as thechild welfare system and the educationalsystem. Unidentified behavior disorderscan contribute to a youth’s coming intocontact with the juvenile justice system.

8. For an expanded discussion of theserecommendations, see Wasserman et al.(2003).

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This Bulletin was prepared under grant num-bers 1998–JB–VX–0115 and 1999–JR–VX–0005from the Office of Juvenile Justice and Delin-quency Prevention, U.S. Department of Justice.

Points of view or opinions expressed in thisdocument are those of the authors and do notnecessarily represent the official position orpolicies of OJJDP or the U.S. Department ofJustice.

The Office of Juvenile Justice and DelinquencyPrevention is a component of the Office ofJustice Programs, which also includes theBureau of Justice Assistance, the Bureau ofJustice Statistics, the National Institute ofJustice, and the Office for Victims of Crime.

U.S. Department of Justice

Office of Justice Programs

Office of Juvenile Justice and Delinquency Prevention

Washington, DC 20531

Official BusinessPenalty for Private Use $300

PRESORTED STANDARDPOSTAGE & FEES PAID

DOJ/OJJDPPERMIT NO. G–91

NCJ 202713Bulletin

AcknowledgmentsGail A. Wasserman, Ph.D., is Director of the Center for the Promotion of MentalHealth in Juvenile Justice, Division of Child Psychiatry, Columbia University, NewYork State Psychiatric Institute, New York, NY. Larkin S. McReynolds, M.P.H., isSenior Data Analyst at the Center. Susan J. Ko, Ph.D., Clinical Director at the Cen-ter at the time of this study, is currently Director of the Service Systems Core at theNational Center for Child Traumatic Stress, University of California, Los Angeles.

*NCJ~202713*

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