Rehabilitative Services

The Role of Mental Health and Specific Responsivity in Juvenile Justice Rehabilitation

Sarah McCormick and Michele Peterson-Badali University of Toronto

Tracey A. Skilling Centre for Addiction and Mental Health, Toronto, Canada and

University of Toronto

Understanding the role that mental health issues play in justice-involved youth poses challenges for research, policy, and practice. While mental health problems are generally not risk factors for criminal behavior according to the risk-needs-responsivity (RNR) framework of correctional psychology practice, prevalence rates are very high and RNR principles suggest that mental health as a responsivity variable may moderate the success of interventions targeted to criminogenic needs. In this study we investigated the relationships among mental health status, criminogenic needs treatment, and recidivism in a sample of 232 youth referred for court-ordered assessments and followed through their community supervision sentence (probation). Youth with mental health needs were no more likely than youth without these needs to reoffend, regardless of whether those needs were treated. Youth who received mental health treatment also more frequently had their criminogenic needs matched across several domains, suggesting an association between mental health treatment and intermediate treatment targets. However, mental health did not moderate the effect of criminogenic needs treatment: youth who had a greater proportion of criminogenic needs targeted through appropriate services were less likely to reoffend, regardless of mental health status. Findings are consistent with the RNR stance that, within a correctional context in which the primary goal of intervention is preventing recidivism, treatment for mental health needs should be in addition to criminogenic needs treatment, not in replacement of it. They also point to the need for continued research to understand precisely how mental health treatment interacts with intervention targeting criminogenic needs.

Keywords: mental health, psychopathology, youth, risk-need-responsivity, recidivism

Mental health problems among youthful offenders have become a considerable concern due to the exceedingly high prevalence rates of these issues (Chitsabesan & Bailey, 2006; Drerup, Croys- dale, & Hoffmann, 2008; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002; Unruh, Gau, & Waintrup, 2009), with rates of any

mental disorder reported to range from 50%–100% among justice- involved youth (Vermeiren, 2003). Concerns include the severity of mental disorders (Shufelt & Cocozza, 2006) as well as high rates of comorbidity (Abrantes, Hoffmann, & Anton, 2005) and associated clinical concerns such as suicidality (Abram, Paskar, Washburn, & Teplin, 2008), self-harm, or experiences of abuse or neglect (Kenny, Lennings, & Nelson, 2007). While studies of offenders serving community supervision orders have found lower rates of comorbidity than in incarcerated samples, levels of psy- chopathology still exceed rates found in community samples (Kenny et al., 2007).

Despite a higher likelihood of having mental health problems, justice-involved youth are less likely than nonoffending youth to have had these problems identified previously or to have received services (Kenny et al., 2007). Mental health problems also pose considerable challenges to frontline staff (e.g., probation officers); mental health issues may be perceived as a barrier to youths’ engagement with rehabilitative programming, with treatment of mental health needs often taking precedence over other issues, including those known to be directly related to risk to reoffend (Haqanee, Peterson-Badali, & Skilling, 2015).

The widespread challenge of mental health problems in the justice system has attracted considerable research attention from researchers interested in psychopathology. This literature includes descriptions of the nature and scope of the problem, the clinical issues, and the context for service delivery, including advocacy for service. In particular, high prevalence rates have raised the ques-

This article was published Online First December 15, 2016. Sarah McCormick and Michele Peterson-Badali, Department of Applied

Psychology & Human Development, Ontario Institute for Studies in Edu- cation, University of Toronto; Tracey A. Skilling, Child, Youth & Family Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada, and Department of Applied Psychology & Human Development, Ontario Institute for Studies in Education, University of Toronto.

The authors are grateful to the Ontario Ministry of Children and Youth Services Youth Justice Services and the Program Effectiveness, Statistics and Applied Research unit of the Ontario Ministry of Community Safety and Correctional Services for provision of data used in this study, Mr. Justice Brian Weagant of the Ontario Court of Justice, and young people who agreed to participate in the research. This research was supported by Grant number 410101516 from the Social Sciences and Humanities Re- search Council (SSHRC) to the second and third authors, and a SSHRC doctoral scholarship to the first author.

Correspondence concerning this article should be addressed to Michele Peterson-Badali, Department of Applied Psychology & Human Develop- ment, Ontario Institute for Studies in Education, University of Toronto, 252 Bloor Street West, 9th Floor, Toronto, Ontario, Canada, M5S 1V6. E-mail: m.petersonbadali@utoronto.ca

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Law and Human Behavior © 2016 American Psychological Association 2017, Vol. 41, No. 1, 55– 67 0147-7307/17/$12.00 http://dx.doi.org/10.1037/lhb0000228

55

tion of the role of mental health in justice involvement and of- fending behavior. Indeed, in the clinical psychopathology litera- ture, mental health problems have been described as an important risk factor for delinquent behavior and for offending among youth (e.g., Abrantes et al., 2005; Plattner et al., 2009; Ulzen & Hamil- ton, 1998; Vermeiren, Jespers, & Moffitt, 2006; Vermeiren, Schwab-Stone, Ruchkin, De Clippele, & Deboutte, 2002).

Risk and Rehabilitation Perspectives on Mental Health

Research on the relationship between mental health problems and criminal behavior has been approached from multiple vantage points. In the context of mental health policy, for example, putative public concern regarding the risk for violence posed by psychiatric populations has led to research— exemplified by projects such as the MacArthur Violence Risk Study (Steadman et al., 1998)— suggesting that adults with serious mental disorders are not at increased risk for violence compared with nondisordered individ- uals living in similar neighborhoods. Within the corrections and criminal justice context, studies of offender populations that have identified mental health as a risk factor for subsequent criminal behavior have been challenged by research on forensic risk pre- diction that firmly asserts that mental health is not a risk factor for recidivism when examined alongside empirically validated risk factors—termed “criminogenic needs” in the risk-need- responsivity (RNR) literature (e.g., Andrews, Bonta, & Hoge, 1990; Andrews et al., 1990; Dowden & Andrews, 1999).

Regardless of the population focus, a common theme across these studies is the importance of attempting to disentangle mental health problems from risk factors that may characterize (and even be more common among) those with mental health problems— but that are not specifically associated with mental health—in order to understand the contribution of mental health problems to outcomes such as (re)offending (e.g., Schubert, Mulvey, & Glasheen, 2011; Skeem, Winter, Kennealy, Louden, & Tatar, 2014). In the adult literature, mental health symptomatology has emerged as a weak predictor of reoffending (Skeem et al., 2014) for offenders in general but also for most offenders with mental illness; the stron- gest predictors of recidivism are criminogenic needs shared by those with and without mental disorder (Bonta, Blais, & Wilson, 2014; Bonta, Law, & Hanson, 1998; Phillips et al., 2005). To our knowledge, only one study of youth focused explicitly on the role of mental health in reoffending has also considered criminogenic needs (Schubert, Mulvey, & Glasheen, 2011), so it remains unclear whether mental health status relates to reoffending. Using data from a sample of justice-involved youth from their Pathways to Desistance Study, Schubert, Mulvey, and Glasheen (2011) exam- ined the relationship between mental health problems— defined in terms of symptoms of affective, mood, attention-deficit/hyperac- tivity disorder (ADHD), and substance use—and reoffending. Controlling for demographic variables and several criminogenic risk markers (e.g., antisocial attitudes, antisocial history, negative peer influence), none of the mental health variables were associ- ated with reoffending, though there was some evidence that sub- stance use problems moderated the relationship between certain criminogenic risk markers (e.g., antisocial history and negative peer influence) and reoffending.

Some of the apparent conflict in research findings regarding the role of mental health in reoffending relates to different conceptu-

alizations and definitions of the construct (McCormick, Peterson- Badali, & Skilling, 2015). In the clinical literature on this topic, mental health is generally defined broadly in terms of diagnoses included within classification systems such as the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM– IV–TR. American Psychiatric Association, 2000). In contrast, within correctional rehabilitation frameworks such as RNR— where the focus is on predicting and addressing risk for reoffend- ing—mental health is often more narrowly defined. Andrews and Bonta (2010) argue that criminogenic needs are sufficient for prediction of reoffending, without the need to consider formal diagnoses “invoking notions of pathology” (p. 81). For example, some of the salient features of disruptive behavior disorders such as impulsivity, anger, aggression inattention, and substance use are captured within the criminogenic need domains of the RNR frame- work and therefore mental health diagnostic categories such as conduct disorder (CD), oppositional defiant disorder (ODD), and ADHD—as well as substance use disorders—would not be con- sidered necessary to add as risk factors for reoffending.

Responsivity and Mental Health

Defined in this way within the RNR framework, additional mental health variables— ones that fall outside of the RNR crim- inogenic need domains—are largely comprised of problems with mood, anxiety, personality functioning, reality testing, and trauma. These variables fall largely into the RNR category of specific responsivity factors: “personal characteristics that regulate an in- dividual’s . . . ability and motivation to learn” (Bonta, 1995, p. 2). From the conceptual definition, specific responsivity variables may be expected to function empirically as moderators of inter- vention effectiveness; successfully addressing responsivity vari- ables (including mental health factors) may improve the effective- ness of interventions targeting criminogenic needs, while failing to address responsivity may compromise the effectiveness of crimi- nogenic needs treatment. Indeed, it has been found that responsiv- ity variables predicted the completion of treatment programming among adult sex offenders, suggesting that intervention outcomes could be improved by attending to responsivity during treatment planning (Beyko & Wong, 2005). However, in contrast to the extensive literature on risk and criminogenic need, research on responsivity has been limited (Hubbard, 2007), perhaps in part due to the substantial variability in how specific responsivity variables have been defined and measured (Vieira, Skilling, & Peterson- Badali, 2009).

The Present Study

In the current study we investigated the role of mental health needs and mental health treatment among youth in the context of criminogenic needs treatment. In keeping with the RNR frame- work, we defined mental health needs as those that are not cap- tured within the RNR risk/needs tools. We also sought to differ- entiate between mental health symptomatology as an initial status variable—the presence or absence of mental health needs—and mental health treatment as a dynamic variable—whether or not youth received treatment for their mental health needs. Mental health treatment alone has rarely been found to reduce recidivism (Skeem, Manchak, & Peterson, 2011). However, it remains unclear

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56 MCCORMICK, PETERSON-BADALI, AND SKILLING

whether the treatment of mental health problems, in addition to treatment targeting criminogenic needs, may improve reoffending outcomes.

We examined three questions: (a) Is mental health—in accor- dance with the RNR definition described above— directly related to recidivism (i.e., are mental health needs related to outcome, and what is the relationship between mental health treatment and recidivism)? Based on the conceptualization of mental health outlined in the RNR framework, and consistent with research that has examined mental health alongside criminogenic needs (e.g., Schubert, Mulvey, & Glasheen, 2011; Skeem et al., 2014) we predicted that the presence of mental health needs would not contribute to reoffending over and above criminogenic needs. (b) Is mental health treatment associated with improved “intermediate outcomes?” Within the RNR conceptualization of mental health treatment as a responsivity factor, addressing mental health needs improves the effectiveness with which treatment providers can address criminogenic needs. As such, we expected that youth whose mental health needs were treated would have more of their criminogenic needs targeted and effectively addressed than youth whose mental health needs remained untreated. For example, successfully addressing a mental health need might improve a youth’s readiness for intervention and/or remove a barrier to addressing a criminogenic need (Kapoor, Peterson-Badali, & Skill- ing, 2016). Certain mental health interventions (e.g., individual therapy) might also address both mental health and criminogenic needs. (c) Is mental health treatment a moderator of criminogenic needs treatment? An RNR conceptualization of mental health as a specific responsivity factor also suggests that the “impact” of mental health treatment on recidivism is achieved indirectly through improvements to the effectiveness of treatment targeting criminogenic needs. To explore these questions we examined the individually identified criminogenic and mental health needs of a sample of community-sentenced youth, assessed which of their needs were addressed during their probation sentence, and docu- mented reoffending.

Method

Participants

The sample consisted of 232 youth referred by youth court judge between January 2002 and January 2010 to a mental health agency in a large urban center in Canada for an assessment to inform sentencing, and who provided consent for use of their information for research. The sample was predominantly male (n � 187; 80.6%) and was ethnically diverse: 35.6% Black, 34.8% White, 9.8% Asian, and 19.7% other ethnicities. Youth ranged in age from 12 to 20 years, (M � 16.12, SD � 1.63). The youths’ most serious charges precipitating referral for assessment included violent of- fenses (e.g., assault, robbery; 59.1%), sexual offenses (16.8%) and nonviolent, nonsexual offenses (e.g., breach of probation, theft, drug-related offenses; 19.4%); offense information was missing for 4.7% of the sample.

Data Sources

Following ethics approvals from the Research Ethics Boards of the University of Toronto and the Centre for Addiction and Mental

Health, as well as research committee approval from the Ontario Ministry of Children and Youth Services— data were coded from existing file information collected from several sources.

Forensic assessments. Assessments had been conducted just prior to youths’ sentencing hearings by a psychiatrist or psychol- ogist on a specialty forensic assessment team within a child and adolescent mental health program. They included information gathered from semistructured clinical interviews with multiple informants, collateral contacts (e.g., teachers), standardized ques- tionnaires and psychological tests to evaluate risk factors and offending history, criminogenic needs, psychoeducational needs, and mental health needs (including diagnoses as well as subthresh- old clinical elevations). All reports concluded with a clinical and forensic summary and formulation and recommendations for in- tervention to address identified needs.

With respect to the assessment of mental health issues specifi- cally, each youth completed a standardized assessment battery that included well-validated assessment tools covering a range of men- tal health issues, including internalizing and externalizing disor- ders, thought problems, attention difficulties, and substance use (e.g., Youth Self-Report, Achenbach, 1991; Children’s Depression Inventory, Kovacs, 2010; Multidimensional Anxiety Scale for Children, March, 2012; Drug Abuse Screening Test—Adoles- cents, Martino, Grilo, & Fehon, 2000). Each youth was then seen by psychologist or a psychiatrist, licensed with a specialty in child and adolescent mental health, who followed up on the results from the standardized assessment tools with a semistructured clinical interview based on practice parameters for the psychiatric assess- ment of youth (King, 1997). Parents also completed a standardized assessment battery and were interviewed by clinicians, as were other sources of relevant clinical information (e.g., past and current mental health service providers, child welfare staff, and school staff). Based on this comprehensive information, diagnoses were developed by psychiatrists or psychologists in accordance with the DSM–IV–TR (American Psychiatric Association, 2000).

Clinicians assessed level of risk and criminogenic needs using the Youth Level of Service/Case Management Inventory (YLS/ CMI; Hoge & Andrews, 2002, 2011). This standardized tool for youth reports risk scores in eight domains including criminal history/current charges and seven dynamic (modifiable) crimino- genic need domains: education/employment, family, antisocial at- titudes, personality and behavior, substance abuse, peers, and use of leisure time. Each of the 42 items is scored by the clinician as present or absent. Items are summed within each criminogenic need domain to yield domain risk scores that can also be classified as low, moderate, or high risk. A total score provides an estimate of overall risk for recidivism, which can be categorized as low, moderate, high, or very high. The YLS/CMI has been validated for prediction of general and specific types of reoffending, including among youth referred for court-ordered mental health assessments (Schmidt, Hoge, & Gomes, 2005; Vieira et al., 2009), receiving mental health services (Olver, Stockdale, & Wong, 2012), and in meta-analyses (Olver, Stockdale, & Wormith, 2009, 2014).

Probation case notes. Following assessment, reports were provided to the court and shared with youths’ probation officers, who provided case management and coordinated services to ad- dress youths’ identified needs. Officers recorded supervision and case management information in computerized “case notes” that included entries on all meetings and telephone calls with or about

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57MENTAL HEALTH AND SPECIFIC RESPONSIVITY

the youth, exchanges with collaterals such as parents, schools, or treatment centers, and system information such as time spent in remand or custodial settings. Case notes were coded for 3 years following assessment or until the date of youths’ first reconviction.

Criminal records. Recidivism data were received from a national police database of all youth and adult convictions as well as corresponding sentences. Recidivism was defined as whether or not a youth had one or more new convictions following the index offense that precipitated the assessment referral, within a follow-up period of approximately 3 years following assessment. To allow time for initiation of probation-coordinated services, new convictions were not counted if they occurred within three months of the assessment.

Coding

Several graduate student research assistants were trained and supervised in coding of information from the assessment reports and case notes into a standardized summary document.

Clinician recommendations. Clinician recommendations from assessment reports were categorized into one of the seven dynamic criminogenic need domains from the YLS/CMI or a “mental health” need category. For each of these categories, the clinician recommendation variable was coded as absent (no men- tion of the need in the report) or present (need mentioned in the clinical summary or recommendations section).

Mental health needs. Youth were coded as having mental health needs if they had a clinician recommendation describing the youth’s mental health needs or explicitly suggesting a particular intervention to address identified needs. These comprised prob- lems with mood, anxiety, personality functioning, reality testing, and trauma, and included those mental health needs that did not reach threshold for formal diagnosis but that clinicians judged relevant to the formulation and recommended treatment (e.g., mood disorders in partial remission or significant personality traits; see Hoeve, McReynolds, & Wasserman, 2013 on the sig- nificance of subthreshold mental health issues). Due to sample size constraints, as well as the fact that comorbidity was the rule rather than the exception, the category of “mental health needs” was not further divided into singular disorders in analyses. As noted above, consistent with the RNR-focused literature, ADHD, substance abuse, CD, and ODD diagnoses were not coded as mental health needs given that diagnostic criteria overlap significantly with, and are captured within, the criminogenic need assessment.

Matching service to recommendations. Following a previ- ously established coding scheme (Peterson-Badali, Skilling, & Haqanee, 2015; Vitopoulos, Peterson-Badali, & Skilling, 2012), in each category where a recommendation was present, probation case notes were reviewed to determine whether the youth received service and, if so, the quantity and quality of service received was assessed. While it was not possible to ascertain detailed informa- tion about quality of services (e.g., treatment integrity) through case notes, there was sufficient information to permit judgments about the extent to which services were evidence-informed (e.g., use of recognized, manualized programs; cognitive– behavioral techniques) and delivered by appropriate service providers (e.g., trained professionals vs. community volunteers). In terms of quan- tity, the length of a program as well as the extent to which the youth attended the program (completed, attended majority of ses-

sions, attended rarely or not at all) were extracted from case notes and informed match coding. It is possible that the same service could be coded as providing a match to more than one need, including multiple criminogenic needs and/or criminogenic and mental health needs. For example, “wrap-around” services (similar to multisystemic therapy) are intentionally developed to address multiple needs—including family, education, attitudes, and mental health—in a holistic manner. If a youth’s participation in such a program met the match criteria outlined below, this would be coded as matching needs identified in several domains.

A score of 0 (no match) was assigned if no service was received, if some case management was attempted but did not result in significant service, or if the youth infrequently attended a service (i.e., less than 25% of sessions). A score of 0 was also assigned if the youth attended a service that only partially met the recom- mended quantity and quality. A score of 1 (match) was assigned if the youth received service coded as adequate in terms of quantity (i.e., youth attended the majority of sessions of a program of the recommended intensity) and/or quality (i.e., evidence-informed at a minimum and delivered by trained personnel). An “overall criminogenic match” was also calculated for each youth—a pro- portion score derived from the number of domains for which a youth received services matching his or her needs divided by the total number of criminogenic need domains with recommenda- tions. Two raters independently reviewed recommendations and case notes for 20% of the files to code for match; reliability was excellent, with Cohen’s Kappas ranging from .89 –1.0 across do- mains. More detailed information regarding the coding system is available on request from the corresponding author.

Results

Preliminary Analyses

In preparation for addressing our primary study questions, we divided the sample into two groups: those who had mental health needs identified by clinicians (57.8%; n � 134) and those with no identified mental health needs (42.2%; n � 98); as noted above, “mental health needs” included diagnoses and subthreshold issues relating to mood, anxiety, thought disorders, trauma, and noncrimi- nogenic personality features. We further divided the “identified men- tal health needs” group into “treated” and “untreated” mental health needs subgroups and compared the three groups to determine whether they differed in terms of demographic variables, offense characteris- tics, overall risk, identified criminogenic needs, and receipt of service for their identified needs (i.e., treatment matching; see Table 1).

Overall, few characteristics distinguished the three groups. Youth identified as having mental health needs did not differ from other youth in terms of age, race/ethnicity, nature of the offense that precipitated the assessment referral, or recidivism. Female youth were less commonly represented in the “no identified mental health needs” group, and were more likely to have treated than untreated mental health needs. However, subsequent analyses did not include gender due to very small cell sizes/empty cells. Youth with untreated mental health needs had significantly higher total risk scores on the YLS/ CMI than did youth with no identified mental health needs. Given the separation between criminogenic needs and our definition of mental health needs, higher YLS/CMI scores in the groups with identified mental health needs did not occur because of “double counting” of

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58 MCCORMICK, PETERSON-BADALI, AND SKILLING

characteristics as contributing to YLS/CMI scores and mental health needs group membership.

For each of the seven dynamic criminogenic need domains, we then examined the YLS/CMI scores and clinician recommenda- tions in “identified mental health needs” and “no mental health needs” groups. As Table 2 shows, youth with mental health needs had higher risk scores in the domains of education, substance use, personality, and leisure, and a trend toward higher risk scores in the family domain. They also showed a trend toward having a higher number of recommendations targeting criminogenic needs overall (M � 5.32, SD � 1.52) compared with youth without

mental health needs (M � 4.90, SD � 1.79); t(182.22) � �1.93, p � .06, Cohen’s d � 0.26, 95% CI [0.047, 0.47], although within each domain there were no group differences in the proportion of youth for whom service recommendations were made.

Finally, turning to receipt of intervention, it is noteworthy that higher risk youth did not receive more criminogenic needs interven- tion than lower risk youth: A factorial risk category by mental health needs ANOVA indicated that— contrary to the risk principle—the number of criminogenic needs addressed did not vary by YLS/CMI risk category, F � 0.78, p � .58; regardless of risk category, youth had an average of 1.50 of their identified criminogenic needs ad-

Table 1 Demographic, Offense, Risk, and Recidivism Variables by Identified Mental Health Needa

Variable No identified mental

health needs Untreated mental

health needs Treated mental health

needs Comparison

n 98 79 55 Average age 16.07 (SD � 1.68) 16.14 (SD � 1.63) 16.16 (SD � 1.56) F(2, 231) � .068, p � .93; �2 � .001 Sex representation (% of

mental health needs group; n in parentheses)

�2(2) � 12.27, p � .01; � � .23

Male 88.8 (87) 81.0 (64) 65.5 (36) Female 11.2 (11) 19.0 (15) 34.5 (19)

Percent race/ethnicity (% of mental health needs group; n in parentheses)

�2(6) � 5.62, p � .47; Cramer’s V � .15

Caucasian 22.9 (11) 40.0 (20) 44.1 (15) Black 43.8 (21) 32.0 (16) 29.4 (10) Asian 10.4 (5) 8.0 (4) 11.8 (4) Other 22.9 (11) 20.0 (10) 14.7 (5)

Index offense (% of mental health needs group; n in parentheses)

�2(6) � 9.14, p � .17; Cramer’s V � .14

Violent 64.5 (60) 53.9 (41) 69.2 (36) Sexual 17.2 (16) 21.1 (16) 13.5 (7) Nonviolent 18.3 (17) 25.0 (19) 17.3 (9)

YLS total score 17.66 (SD � 9.65) 22.96 (SD � 8.93) 20.69 (SD � 8.78) F(2, 218) � 6.94, p � .01; �2 � .06 YLS criminal history

domain score 1.67 (SD � 1.81) 2.14 (SD � 1.89) 1.73 (SD � 1.88) F(2, 199) � 1.23, p � .28; �2 � .01 Recidivism: yes (n in

parentheses) 53.1% (52) 67.1% (53) 53.7% (29) �2(2) � 4.28, p � .12; Cramer’s V � .12 Days to recidivism 473.17 (SD � 271.96) 486.51 (SD � 314.90) 600.79 (SD � 329.67) F(2, 133) � 1.84, p � .16; �2 � .03

Note. YLS � Youth Level of Service. a Valid percentages are reported where data were unavailable.

Table 2 YLS/CMI Scores and Clinician Recommendations Across Criminogenic Need Domains

Criminogenic need domain

No identified mental health needs (n � 98)

Identified mental health needs (n � 134)

Comparison YLS scoresYLS scores % w/clinician

recommendations YLS scores % w/clinician

recommendations

Education 3.74 (2.15) 87.8 4.53 (1.95) 94.8 t(198) � �2.68, p � .01; Cohen’s d � .39, 95% CI [.13, .65] Family 3.05 (1.83) 75.5 3.52 (1.64) 91.0 t(198) � �1.91, p � .10; Cohen’s d � .27, 95% CI [.05, .50] Substance use 1.34 (1.53) 44.3 1.99 (1.74) 59.0 t(193.38) � �2.82, p � .01; Cohen’s d � .40, 95% CI [.18, .61] Personality/behavior 2.80 (2.10) 73.5 3.96 (2.03) 86.6 t(198) � �3.95, p � .001; Cohen’s d � .57, 95% CI [.30, .83] Attitude 1.70 (1.72) 51.0 1.99 (1.70) 55.2 t(198) � �1.20, p � .23; Cohen’s d � .17, 95% CI [�.05, .39] Leisure 1.41 (.99) 77.6 1.75 (.92) 68.7 t(198) � �2.50, p � .01; Cohen’s d � .36, 95% CI [.24, .48] Peers 2.13 (1.34) 77.6 2.28 (1.25) 76.1 t(198) � �.83, p � .41; Cohen’s d � .12, 95% CI [�.05, .28]

Note. YLS/CMI � Youth Level of Service/Case Management Inventory; YLS � Youth Level of Service.

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dressed. However, youth with mental health needs had more crimi- nogenic needs addressed (M � 1.78) than those without mental health needs (M � 1.12), F � 6.98, p � .05, Cohen’s d � 0.43, 95% CI [.24, .63]. The interaction between risk category and presence of mental health needs was not significant, F � 1.20, p � .31.

Is Mental Health Directly Related to Recidivism?

The first main research question was whether mental health, as defined in the RNR framework, could be described as a risk factor for recidivism even without including other variables known to be potent predictors of reoffending (i.e., criminogenic needs). Youth with mental health needs were no more likely to reoffend (59.3%, n � 86) than youth with no mental health needs, 53.1%, 52; �2(1) � 0.93, p � .34, � � .06. Using Cox regression, no group difference was found in number of days from assessment to recidivism, B � �18, Exp(B) � .83, CI [.59, 1.18], p � .31, between recidivists identified as having mental health needs (M � 522.65, SD � 318.64) and those without (M � 473.17, SD � 271.96); �2(1, N � 230) � 1.05, p � .31.

We next examined whether mental health treatment was asso- ciated with recidivism in the subsample of youth with identified mental health needs. Of these 144 youth, 41.0% (n � 59) received treatment. The treated group was no less likely to reoffend (52.5%) than the untreated group, 64.4%; �2(1) � 2.04, p � .15, � � �.12. Of youth who did reoffend, those with treated (M � 587.68 days, SD � 325.16) and untreated (M � 490.04 days, SD � 310.52) mental health needs did not differ in days to re-offense, B � .40, Exp(B) � 1.49, CI [.94, 2.34 ], p � .09.

Is Mental Health Treatment Associated With Improved Intermediate Outcomes?

The next question focused on mental health as a responsivity factor in terms of its relationship to intermediate treatment outcomes (i.e., the receipt of appropriately matched services for identified crimino- genic needs). Thus, for the subsample of youth with identified mental health needs, we examined whether criminogenic needs were more likely to be successfully addressed when mental health needs were also addressed. First, we examined the relative sizes of the groups: Of the youth identified as having a mental health need and a given criminogenic need, what proportion had both, only one, or neither need addressed through services? In the domains of education/em- ployment, family, and personality/behavior, most youth had both their

criminogenic need and their mental health needs matched or else had neither need matched; it was much less common for youth to have either their mental health or criminogenic need (but not both) matched (see Table 3). In the areas of substance abuse, attitudes, leisure, and peers, youth were more likely to have their mental health needs alone matched than to have both mental health and criminogenic needs matched. Unfortunately, the most common outcome across all need areas except education/employment was that around half of youth had neither their criminogenic nor their mental health needs met.

In order to explore this finding further, for each criminogenic need domain, we examined whether this “neither needs met” group differed from the “both needs met” group in terms of demographic and offense characteristics, mental health diagnoses, and number of assessment recommendations (youth who had either their crim- inogenic or mental health needs met but not both were excluded from analysis, in large part because these groups were very small; see Table 3). Overall, few characteristics distinguished the groups; they did not differ in age, ethnicity, type of index offense, or gender (except youth with substance abuse needs, where girls were more likely than boys to have both needs matched, �2(1) � 8.77, p � .01). For two criminogenic need domains, youth in the “neither need met” group had higher total YLS/CMI scores: edu- cation/employment, t(87) � 2.69, p � .01, Cohen’s d � 0.61, 95% CI [1.17, 2.34] and family, t(73) � 2.23, p � .05, Cohen’s d � 0.47, 95% CI [1.47, 2.41]. In terms of diagnoses, the only signif- icant finding was that youth with a diagnosis of a mood disorder were more likely to have both their mental health and criminogenic needs matched across all seven criminogenic need areas (educa- tion/employment: �2(1) � 8.18, p � .004; family: �2(1) � 9.53, p � .05; substance use: �2(1) � 8.73, p � .05; personality/ behavior: �2(1) � 7.17, p � .05; attitude: �2(1) � 12.41, p � .001; leisure: �2(1) � 6.82, p � .01; peers: �2(1) � 9.02, p � .01).

Finally, when overall treatment match was examined, youth whose mental health needs were treated had a significantly higher proportion of their criminogenic needs addressed (M � 55%, SD � .29) compared with youth whose mental health needs were not treated (M � 20%, SD � .24), t(133) � �7.84, p � .001; Cohen’s d � 1.31, 95% CI [1.27, 1.34].

Is Mental Health Treatment a Moderator of Criminogenic Needs Treatment?

Prior to addressing the moderation question, we first examined whether treatment of criminogenic needs had the expected effect

Table 3 Likelihood of Treatment of Criminogenic Need Domains by Treatment of Identified Mental Health Need(s)

Criminogenic need area na

Neither need treated

Both needs treated

Criminogenic need only treated

Mental health only treated �2(1) �

Education/employment 138 39.1% (n � 54) 32.6% (n � 45) 18.1% (n � 25) 10.1% (n � 14) 26.91, p � .001 .44 Family 134 43.3% (n � 58) 27.6% (n � 37) 14.9% (n � 20) 14.2% (n � 19) 21.80, p � .001 .40 Substance use 89 47.2% (n � 42) 16.9% (n � 15) 10.1% (n � 9) 25.8% (n � 23) 5.27, p � .02 .24 Personality/behavior 128 48.4% (n � 62) 28.9% (n � 37) 13.3% (n � 17) 9.4% (n � 12) 36.15, p � .001 .53 Attitude 82 50.0% (n � 41) 18.3% (n � 15) 7.3% (n � 6) 24.4% (n � 20) 9.54, p � .002 .34 Leisure 105 49.5% (n � 52) 18.1% (n � 19) 6.7% (n � 7) 25.7% (n � 27) 12.03, p � .001 .34 Peers 115 53.9% (n � 62) 13.9% (n � 16) 4.3% (n � 5) 27.8% (n � 32) 12.54, p � .001 .33

a Each of the rows above represents analysis of a subsample of youth: those who had clinician-identified mental health needs and a clinician-identified criminogenic need in the given area. Youth who had mental health needs but not a given criminogenic need were excluded from the sample for each analysis represented, as were youth who had a given criminogenic need but no identified mental health needs.

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on recidivism outcomes. Across almost all criminogenic need areas for the total sample, youth whose needs were matched were less likely to reoffend (see Table 4). Exceptions included family and substance abuse, in which matching of that criminogenic need alone was not associated with a decreased proportion of reoffend- ing. We then examined reoffending outcomes more specifically in the subsample of youth who had identified mental health needs. For each criminogenic need domain, we investigated whether youth who had both their mental health and criminogenic needs met were less likely to reoffend compared to those youth who had neither need met. Across four criminogenic need areas, youth who had criminogenic and mental health needs matched were less likely to offend (see Table 5). Exceptions included substance abuse, leisure, and peers, in which matching of both needs was not associated with a decreased proportion of reoffending; this finding should be interpreted with caution given small cell sizes.

We also examined the subset of youth with mental health needs who reoffended to examine whether youth reoffended later if both of their needs were met than if neither of their needs were met. Com- pared with youth with neither need matched, youth with both needs matched had significantly more days to reoffense in the domains of education/employment (M � 452.89 vs. 622.37, respectively); t(55) � �2.05, p � .05; Cohen’s d � 0.58, 95% CI [�75.62, 74.45]; attitudes (M � 491.83 vs. 876.60, respectively); t(33) � �2.56, p � .05; Cohen’s d � �1.27, 95% CI [�101.47, 98.92]; peers (M � 463.50 vs. 827.75, respectively); t(46) � �3.35, p � .01; Cohen’s d � 1.32, 95% CI [�79.17, 76.53]; and leisure (M � 416.63 vs. 734.44, respectively); t(39) � �3.23, p � .01; Cohen’s d � 1.25, 95% CI [�79.05, 76.55].

Next, hierarchical logistic regression was used to examine whether treatment of mental health needs functioned as a respon- sivity factor (i.e., as moderator of the effect of criminogenic needs treatment on whether or not youth reoffended; see Table 6). To control for risk, the YLS/CMI criminal history score was included as a predictor in the first step of the model. This score was chosen as a substitute for the YLS/CMI total score because of the signif- icant overlap between the YLS/CMI domain scores used to inform clinician recommendations and the subsequent criminogenic needs match score for each youth. Criminal history was strongly corre- lated with YLS/CMI total score, r(209) � .66, p � .01, suggesting that it was a robust proxy for the total risk score that did not overlap with the other variables in the analysis.

The effect of matching treatment to youths’ identified criminogenic needs (youths’ overall match score), as well as whether their mental health needs were matched or not, were entered as predictors in Step 2. Moderation was tested by including the Overall Match Mental Health Match interaction term at Step 3. As seen in Table 6, criminal history was a significant predictor of reoffending at each step. Overall matching to criminogenic needs also significantly predicted reoffend- ing such that each increase in overall match was associated with decreased odds of reoffending. However, whether or not youths’ mental health needs were treated did not predict recidivism, nor did it moderate the effect of treating criminogenic needs on the outcome.

Discussion

Mental health concerns are highly prevalent among justice- involved youth, yet previous research and scholarly literature has been unclear or conflicting with respect to the role of mental health

Table 4 Percentage of Youth Who Reoffended by Treatment of Criminogenic Need Domain

Criminogenic need area n Need not treated Need treated �2(1) �

Education/employment 222 72.0 (n � 85) 43.3 (n � 45) 18.85, p � .001 �.29 Family 204 62.6 (n � 82) 50.7 (n � 37) 2.74, p � .10 �.12 Substance use 131 66.0 (n � 66) 58.1 (n � 18) .65, p � .42 �.07 Personality/behavior 198 77.6 (n � 97) 39.7 (n � 29) 28.57, p � .001 �.38 Attitude 130 72.4 (n � 76) 44.0 (n � 11) 7.35, p � .01 �.24 Leisure 178 68.1 (n � 92) 39.5 (n � 17) 11.25, p � .001 �.25 Peers 191 67.7 (n � 105) 38.9 (n � 14) 10.36, p � .001 �.23

Table 5 Percentage of Youth Who Reoffended by Treatment of Both Mental Health and Criminogenic Need Domain

Treated mental health and criminogenic

need area n Neither need

treated Both needs

treated �2(1) �

Education/employment 92 76.5 (n � 39) 46.3 (n � 19) 8.86, p � .003 �.31 Family 87 68.5 (n � 37) 48.5 (n � 16) 3.45, p � .06 �.20 Substance use 53 75.0 (n � 30) 69.2 (n � 9) .17, p � .68 �.06 Personality/behavior 93 80.0 (n � 48) 45.5 (n � 15) 11.63, p � .001 �.35 Attitude 51 76.9 (n � 30) 41.7 (n � 5) 5.30, p � .02 �.32 Leisure 65 70.2 (n � 33) 50.0 (n � 9) 2.33, p � .13 �.19 Peers 73 70.7 (n � 41) 53.3 (n � 8) 1.63, p � .20 �.15

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issues in risk prediction and treatment outcomes, leaving implica- tions for treatment planning unclear. In contrast to the broader clinical and psychopathology literature on this topic, in the RNR literature mental health problems have been defined more nar- rowly (i.e., excluding externalizing disorders, ADHD, and sub- stance abuse because their salient features are already captured in the criminogenic need domains) and described as responsivity variables (e.g., Bonta, 1995). Using this RNR-based definition of mental health, we compared the major hypotheses regarding the role of mental health as either a risk factor for recidivism or as a responsivity variable that influences the effectiveness of interven- tion. It is important to note that there has been some conflation in the previous literature between discussions of mental health in terms of needs (i.e., mental health problems) versus treatment. In order to speak to this, we examined both dimensions explicitly.

Frequency of Mental Health and Criminogenic Needs

Consistent with previous studies, the proportion of youth iden- tified as having mental health needs was high (e.g., youth serving community orders, Kenny et al., 2007; youth in detention, Teplin et al., 2002; and serious offenders, Schubert et al., 2011), espe- cially in comparison with rates found in general community (non- justice) samples. There was a trend toward female youth being more likely to be identified as having mental health needs (e.g., Cauffman, Lexcen, Goldweber, Shulman, & Grisso, 2007) and female youth were more likely to have treated than untreated mental health needs (Lopez-Williams, Stoep, Kuo, & Stewart, 2006).

Youth with mental health needs tended to have more crimi- nogenic needs identified by clinicians than those without men- tal health needs and youth with untreated mental health needs had higher total risk scores than youth without mental health

needs. These findings suggest that youth with mental health problems are characterized by greater criminogenic risk than those without, which is consistent with findings from the adult literature (Skeem, Nicholson, & Kregg, 2008; Skeem et al., 2014). This relationship between mental health needs and crim- inogenic needs suggests that, while a common set of risk factors may be sufficient for predicting reoffending, individuals with mental illness may present with more of these risk factors (Skeem et al., 2011, 2014). When examined in terms of specific criminogenic need domains, youth identified with mental health needs were comparable with other youth in the areas of criminal history, family, peers, and attitudes, but they had higher risk/ need scores in education/employment, substance abuse, leisure, and personality/behavior. It is unclear what may be contributing to higher needs in these areas. It is possible that youth whose functioning is impaired by mental health needs demonstrate this same impairment in the areas of education (e.g., poor school attendance) and leisure time (e.g., lack of engagement in struc- tured prosocial activities). Higher scores on the substance use domain are predictable given the high rates of comorbidity between mental health needs and substance abuse (Armstrong & Costello, 2002; Chan, Dennis, & Funk, 2008; Kessler et al., 1997; Rohde, Lewinsohn, & Seeley, 1996). Finally, several features assessed by the personality/behavior domain may also be features of clinical diagnoses such as ADHD (e.g., poor frustration tolerance, impulsivity), which were not classified as mental health problems in the present study but which are frequently comorbid with mental health problems such as anx- iety and depression (Biederman, Newcorn, & Sprich, 1991; Jarrett & Ollendick, 2008; Meinzer, Pettit, & Viswesvaran, 2014); thus, youth with these features may also be more likely to have mental health problems. Clinical literature outside

Table 6 Overall Criminogenic Needs Match, Mental Health Match, and Criminogenic Needs Mental Health Match Interaction as Predictors of Recidivism, Controlling for Static Risk

Model variables SE Wald’s �2 df � exp(B)

CI (95%)

Lower Upper

Model (Step) 1 Criminal history .54 .13 17.32 1 .00 1.72 1.33 2.21 Constant �.40 .28 2.00 1 .16 .67 Overall model at Step 1 21.70 1 .00

Model (Step 2)a

Criminal history .48 .13 12.68 1 .00 1.61 1.24 2.09 Overall match �2.52 .91 7.72 1 .01 .08 .01 .48 Mental health match �.68 .57 1.42 1 .23 .50 .16 1.55 Constant 1.08 .69 2.46 1 .12 2.94 Step 2 8.99 2 .01 Overall model at Step 2 30.68 3 .00

Model (Step 3) Criminal history .48 .14 12.71 1 .00 1.62 1.24 2.141 Overall match �3.16 1.41 4.99 1 .03 .04 .003 .68 Mental health match �1.20 1.04 1.34 1 .25 .30 .04 2.31 Overall Match Mental Health Match 1.14 1.86 .37 1 .54 3.12 .08 119.17 Constant Step 3 .38 1 .54 Overall model at Step 3 31.06 4 .00

a Another analysis was performed that included sex as a predictor. It was not significant and so is not presented here in favor of the more parsimonious model.

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correctional psychology frameworks such as RNR has included both “criminogenic” diagnoses (e.g., substance use disorders) and noncriminogenic diagnoses (e.g., depression) together in discussions of mental health problems. These definitional dif- ferences have, in part, contributed to confusion and apparent conflicts in findings regarding the role of mental health prob- lems as a risk factor for recidivism (for a fuller discussion of these differences, see McCormick, Peterson-Badali, & Skilling, 2015).

Mental Health as “Risk” Versus “Responsivity”

Indeed, previous literature has often used the language of “risk” in discussing the high rates of mental health problems among offenders and the association between mental health needs and judicial involvement. Yet within a more forensic definition of risk as a relationship between an identified variable and recidivism among youth who have already offended at least once, mental health needs were not associated with reoffending, even within a simple model that did not include other, well-established, crimi- nogenic needs. Similarly, among youth identified as having mental health needs, treatment of noncriminogenic mental health prob- lems was not significantly associated with reoffending. The pres- ent results suggest that treatment of mental health needs alone (as defined from an RNR perspective to exclude diagnoses character- ized by criminogenic features) will not lead to reduced recidivism. These conclusions are consistent with those of Schubert, Mulvey, and Glasheen (2011) and Skeem, Winter, Kennealy, Louden, and Tatar (2014), whose studies of youth and adult offenders, respec- tively, reported that mental health variables are not predictive of recidivism when included alongside criminogenic risk factors. However, along with mood and anxiety problems, Schubert et al. (2011) included ADHD and substance use as mental health pre- dictors, whereas those variables would have been captured as criminogenic needs and not as “mental health” in our study using the RNR-based definition of mental health. It is thus interesting to note that substance use was the one mental health predictor that moderated the relationship between criminogenic risk factors and outcomes (e.g., rearrest).

If mental health is best conceptualized as a specific responsivity variable for justice-involved youth—that is, not a direct risk factor for reoffending but of relevance to treatment engagement and success—then its influence may be at the intermediate stage of completion of criminogenic needs treatment. Indeed, we found an association between mental health treatment and intermediate treatment outcomes: youth who received appropriate mental health intervention were also more likely to have their criminogenic needs addressed in several domains compared with youth whose mental health needs were not treated. There was also a significant relationship between mental health treatment matching and the total number of identified criminogenic needs that were met through service. The alternative conceptualization of responsiv- ity—that of mental health treatment as a moderator of the success of intervention targeted to criminogenic needs—was not sup- ported; youth who had more of their criminogenic needs addressed through intervention were less likely to reoffend regardless of mental health functioning.

At this time it is unclear why there is an association between completion of intervention targeting mental health and crimino-

genic needs. Two possibilities seem apparent. First, this associa- tion may reflect systems and implementation considerations as opposed to a particular “specific responsivity” effect. For example, it may be that youth who receive mental health services are also connected to higher quality, more effective services targeting criminogenic needs. Another possibility is that their needs are being met through more comprehensive services. For example, youth identified as having mental health issues may be paired with more experienced probation officers who are more able to effec- tively connect youth with services. Or, youth referred for mental health services may be directed to agencies that provide more wraparound services. This type of effect would reinforce the need for general best practice approaches and high quality services to improve outcomes for all justice-involved youth, not only those with mental health needs.

Alternatively, the association between receiving mental health and criminogenic needs interventions may actually reflect the way that specific responsivity is conceptualized: Mental health treat- ment may remove a barrier that would otherwise interfere with rehabilitative programming. For example, mental health treatment may stabilize affected youths and thereby facilitate youths’ en- gagement in criminogenic needs intervention. In this case, mental health treatment would be indicated for affected youth in order to bolster engagement in criminogenic needs treatment. Indeed, men- tal health needs have also been described as “clinical destabiliz- ers”—factors indirectly related to recidivism—and identification of these clinical destabilizers alongside criminogenic needs can add to risk prediction (Taxman & Caudy, 2015). Furthermore, Taxman and Caudy (2015) found that adult offenders with high levels of destabilizers, such as mental health needs, also tended to have high levels of criminogenic needs (consistent with our find- ings here) and therefore they suggested that these offenders may require ancillary services in addition to more intense forensic therapy services in order to improve desistance. Future research is needed to directly examine these two possibilities.

Addressing Youths’ Mental Health and Criminogenic Needs

The “good news” in our findings is that treatment of mental health needs was associated with increased likelihood that crimi- nogenic needs would be addressed; in turn, intervention addressing youths’ criminogenic needs was associated with reduced likeli- hood of reoffending. The “bad news” is that—although, as ex- pected, youths’ identified criminogenic needs increased with risk level— contrary to the risk principle, the number of needs ad- dressed during probation did not change as risk increased. In addition, the most common “intermediate outcome” was that youth had neither their mental health nor their criminogenic needs matched during their probation terms, with 40%–54% of youth across the various criminogenic need domains having neither need addressed. The search for characteristics that might differentiate youth who had both their mental health and criminogenic needs met versus neither type of need met yielded few group differences. Youth with higher overall risk scores were more likely to fall into the “neither need matched” group in the domains of education/ employment and family. It is possible that these youth may have more needs that are left untreated as probation officers attempt to address the perceived most urgent or most treatable needs first

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(Haqanee et al., 2015) or because these youth may be more challenging to engage in service (Andrews & Bonta, 2010). On the other hand, youths with a diagnosis of a mood disorder were more likely to have both their mental health and criminogenic needs matched than to have neither type of need addressed in treatment, perhaps because youth with mood disorders are more likely to be referred for comprehensive services than youth with other types of disorders (i.e., a systems effect) or because they are more amena- ble to engage in services (i.e., a specific responsivity effect).

Together, these findings suggest several implications for ser- vice. First is the need for services to be provided in a manner consistent with the risk principle: High-risk youth have more criminogenic needs and these needs should be addressed (Andrews & Bonta, 2010) regardless of mental health status. Further, the present results do not support treatment of noncriminogenic mental health needs alone as an effective way to reduce reoffending; service providers must also attend to criminogenic needs in order to meet the goal of reduced involvement in the justice system. The finding that youth with treated mental health needs also had more of their criminogenic needs treated suggests that these youth may experience a better standard of care. It may be that youth have better outcomes with wraparound services than with referral to several siloed programs. Alternatively, youth receiving mental health treatment may have had an additional source of intervention targeting domains such as education, family functioning, and be- havior, which may be targets for improved functioning from both mental health and criminogenic needs perspectives, and which correspond to the domains in which we found that more youth had both needs met. Further research is needed to understand this finding, but these initial results suggest that youth who received mental health services benefitted from more comprehensive ser- vices.

Considerations for Interpretation: Strengths and Limitations

The use of data from comprehensive, systematic, and individu- alized assessments of youths’ psychological functioning, risk, and criminogenic needs as the basis for analyses is a significant meth- odological strength of the current study. Several previous studies on the mental health needs of youth in the justice system have relied on identification through self-report or screening measures (e.g., Foster, Qaseem, & Connor, 2004; Hartinger-Saunders et al., 2011) or have relied on referrals to document the types of services youth were thought to have received (e.g., Hoeve et al., 2013). The use of comprehensive professional assessments arguably provides a more stringent test of hypotheses as to the role of mental health. In addition, information from the individualized assessment, treat- ment, and offending histories was particularly suited to the anal- ysis of specific responsivity, which has been described in terms of variables that may have important treatment considerations for particular individuals but not for offenders in general. This point is important because, while the principle of specific responsivity has significant implications for efficacy of treatments designed to address criminogenic needs, it has been neglected—from a re- search perspective—relative to the other RNR principles. Finally, in contrast to many studies examining the relationship between mental health variables and (re)offending, we examined not only the role of mental health needs or diagnoses, but the role of those

needs at the outset of intervention and the effect of treatment in the context of criminogenic needs, assessed using a strong evidence- based framework.

In addition to these important strengths, several limitations must be acknowledged. First, because we drew our sample from an agency tasked with assessing youth for the courts, all participants had their mental health needs assessed. It is unclear to what extent our findings generalize to the overall population of justice- involved youth, in particular those whose mental health needs have not been identified via screening or assessment. Depending on jurisdictional practice (e.g., whether mental health screening is mandated), the proportion of youth in the justice system with unidentified mental health needs could be quite high. It would be interesting and instructive to conduct similar research in a juris- diction that mandates universal screening. With respect to the mental health assessments themselves, while the assessments were in keeping with best practice parameters in the field (e.g., King, 1997) and each youth and parent completed a standard battery of well-validated mental health screening measure, the interviews themselves were not conducted using a structured interview guide nor is information available on the reliability of the specific diagnoses across clinicians. While this type of clinical interview- ing is common practice in the field, low reliability of diagnoses is a known issue (e.g., Aboraya, Rankin, France, El-Missiry, & John, 2006) and therefore has the potential to impact results.

Second, due to sample size constraints, it was not possible to assess the moderating effect of mental health treatment on treat- ment of individual criminogenic need domains, but only on the overall proportion of needs addressed. Similarly, due to small cell sizes we were largely unable to examine relationships within specific diagnoses. Future research should examine specific diag- noses as well as clusters of disorders (given high rates of comorbid disorders) to better understand the relationship between mental health problems and service referral in a justice context at the systems level, as well as responsiveness to service in terms of individual offenders. Finally, our sample included many more male than female youth. While this imbalance is representative of the justice system generally, the relationship between mental health and offending for female youth in particular merits further study.

The conclusion that treatment of mental health problems was not associated with reoffending may be conservative given the findings on intermediate treatment targets; the great majority of youth across most criminogenic need domains had either both or neither of their criminogenic and mental health needs matched, while comparatively few had only one or the other need matched. Accordingly, while there was not a complete separation in the data, there was limited power to differentiate between groups to detect an effect between youth with only criminogenic needs matched and youth with both types of needs matched. Until the reasons for the association with intermediate treatment targets are better un- derstood we may be limited in the analysis of mental health treatment as a moderator of criminogenic needs treatment. It is also important to note that—while we consider the real-world context of the study to be a methodological strength—the information used to code services youth received was derived from probation offi- cers’ case notes rather than directly from service providers. As such, detail regarding variables (e.g., engagement, quality of the relationship with the provider) relevant to treatment efficacy was

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64 MCCORMICK, PETERSON-BADALI, AND SKILLING

not consistently available. Certainly, future studies would benefit from such information obtained systematically—and from proba- tioners themselves where appropriate, as well as from treatment providers.

In terms of the generalizability of the findings, the participants in this study were youth under community supervision and so comparisons to incarcerated youth should be made with caution. It should be noted that despite the fact that participants had been referred for comprehensive mental health assessments, this was not a sample exclusively of youth with mental health needs, as a significant number of youth were not identified as having mental health concerns following assessment. Indeed, the proportion of youth identified as having mental health difficulties in this study is consistent with the results of other studies based on general sam- pling of justice populations (Shufelt & Cocozza, 2006).

Concluding Thoughts

We propose that these findings reflect on the principle of spe- cific responsivity in two major ways. The first is that this principle may serve as an acknowledgment of the relevance of other goals of treatment, but that these alternative goals should be explicitly understood as separate from the major rehabilitative goal of re- ducing reoffending. Hence, treatment in service of these goals should be in addition to criminogenic needs treatment, not in replacement of it. Other goals may be deemed worthy because of their potential to improve general psychosocial functioning in accordance with social values such as meeting a duty of care for vulnerable persons, but these findings reinforce that treatment providers and policymakers should clearly articulate the goals of service by which outcomes are to be judged.

The second facet suggested by these findings is that respon- sivity variables cannot be understood as a static list but must be assessed in a dynamic and molecular way: dynamic, in that their relevance must be continually reassessed, as it may shift over time and in response to other variables; and molecular, in that they must be assessed on an individualized basis, for a partic- ular offender in a particular program. A list of potential respon- sivity variables may serve as a useful guide to treatment pro- viders but should be interpreted through a process of ongoing assessment; purported responsivity variables are not automati- cally relevant to the offender’s functioning in treatment pro- grams, even if present. Treatment providers should maintain an ongoing awareness of whether these needs have become rele- vant and are having an impact on the offender’s capacity to engage in treatment. Hence, mental health may directly impact treatment engagement for some youth but operate indepen- dently for other youth.

Our results are consistent with findings from the scant research that has examined the relationship of mental health to reoffending alongside criminogenic needs (Schubert, Mulvey, & Glasheen, 2011; Skeem et al., 2014). However, despite the fact that neither mental health needs nor treatment of those needs predicted reoff- ending, our findings also point to the need for continued research to understand precisely how mental health treatment interacts with intervention targeting criminogenic needs. Youth may have mental health needs that are not directly relevant to the success of crim- inogenic needs treatment. Nevertheless, youth who receive com- prehensive services targeting multiple domains of need have better

outcomes. These services provide a benefit to individual youth and, in turn, to society.

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Received January 17, 2016 Revision received October 22, 2016

Accepted October 22, 2016 �

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