title: Understanding clinical complexity in delinquent youth: comorbidities, service utilization, cost, and outcomes.
abstract: This study describes the extent and severity of multiple comorbidities in ajuvenile detention center population, and explores how these numerous problems impact the utilization of treatment services, costs, and outcomes including those for substance abuse, mental illness, and criminal activity. Cluster analyses of the outcome scales at intake yielded two groups: youth high (42%) and youth lower (58%) on all factors. Girls experienced the most significant impairments across emotional problems, behavior complexity, internal mental distress, and victimization domains, utilized significantly more units of residential treatment,individual counseling and case management, and had the highest treatment costs. The total cost of services ($1,171,290, N = 114) was significantly related to substance problems in the past year (r = .219, p < .05), emotional problems (r = .237, p < .05), behavior complexity (r = .318, p < .05), internal mental distress (r = .263, p < .05), environmental risk (r = .205, p < .05), and conflict tactics (r = .240, p < .05). Despite initial differences in measures of baseline severity, high and low cluster youth, and boys and girls in general, achieved similar results on the key outcome variables 12 months later. Study implications include a need for co-occurring, integrated treatment efforts that address family, emotional, and mental health problems of delinquent youth (especially females) in order to improve their ability to successfully attend to substance abuse problems and interpersonal conflicts.
authors.affiliation: Department of Justice Studies, Kent State University, Kent, OH 44242, USA. dhussey@kent.edu
authors.forename: David L
authors.initials: DL
authors.lastname: Hussey
authors.forename: Allyson M
authors.initials: AM
authors.lastname: Drinkard
authors.forename: Lynn
authors.initials: L
authors.lastname: Falletta
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Flannery
mesh_terms: D000293:Adolescent; D000437:Alcoholism / Q000191:economics / Q000453:epidemiology / Q000534:rehabilitation; D003131:Combined Modality Therapy / Q000191:economics; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D015897:Comorbidity; D003365:Costs and Cost Analysis; D005196:Family Therapy / Q000191:economics; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007604:Juvenile Delinquency / Q000191:economics* / Q000534:rehabilitation* / Q000706:statistics & numerical data; D008297:Male; D002189:Marijuana Abuse / Q000191:economics / Q000453:epidemiology / Q000534:rehabilitation; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology / Q000534:rehabilitation; D009820:Ohio; D011330:Prisons; D012017:Referral and Consultation / Q000191:economics / Q000706:statistics & numerical data; D012114:Residential Treatment; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000191:economics* / Q000453:epidemiology / Q000534:rehabilitation*; D016896:Treatment Outcome; D014600:Utilization Review / Q000706:statistics & numerical data