Faculty Bibliography

As of 2018, more than 37,000 American youth were residing in juvenile detention or residential placement facilities.¹ Prevalence studies have demonstrated high rates of psychiatric illness in this population, with estimates ranging from 50% to 75%.²

The majority of youth in the juvenile justice system have experienced multiple traumatic events in their lives, including community violence, physical abuse, neglect, and traumatic loss. These high prevalence rates, coupled with the known negative consequences of trauma in childhood and adolescence, have led to a greater emphasis on implementing trauma-informed services and practices within juvenile justice settings. However, although many stakeholders and government entities have expressed support for creating more trauma-informed juvenile justice systems, there is still limited empirical knowledge about which interventions are most effective at improving outcomes, particularly at the organizational or facility level. In an effort to fill this gap, the current study evaluated the impact of a trauma-informed milieu intervention, including skills training for youth and training for staff, on rates of violence at two secure juvenile detention facilities (N = 14,856) located in a large Northeastern city. The analyses revealed that the intervention was significantly related to a reduction of violent incidents in Facility A, with no impact on incidents in Facility B. Follow-up analyses revealed that a larger proportion of eligible youth in Facility A completed the skills group program as compared with eligible youth in Facility B (16% vs. 9%). This finding has important implications for the implementation of trauma-informed interventions for youth in juvenile detention settings, as it suggests that to impact outcomes at the facility level, a minimum threshold of youth may need to be exposed to the intervention. In addition, reductions in violence at Facility A were only realized after both staff training and youth skills components were implemented, suggesting that both components are necessary to create change at the facility level. Future research is needed to further explore the impact of organizational and implementation-level factors on trauma-informed care outcomes in juvenile justice settings.

Recent efforts to reform and improve the juvenile justice system have overlooked one critically important issue-the widespread failure to routinely screen for intellectual and developmental disabilities (I/DD) in young offenders. Pursuant to the Americans with Disabilities Act and Individuals with Disabilities Education Act, offenders with I/DD must receive appropriate accommodations. Yet across the country, adolescents and adults with I/DD must engage with the juvenile justice system without appropriate supports and often with their disabilities unknown to corrections staff, lawyers, judges, and other personnel.

Since the Third Edition, the Diagnostic and Statistical Manual of Mental Disorders (DSM) has increasingly incorporated developmentally informed criteria for posttraumatic stress disorder (PTSD) because of recognition that children and adolescents can manifest PTSD differently from adults. The most recent edition, DSM-5, among other changes, has introduced a developmental subtype for children six years of age or younger. As pediatric PTSD features very prominently in both civil and criminal proceedings, it is vital that the expert witness be familiar with the updated criteria and know how to interview traumatized youth appropriately in the forensic setting. In this review, we discuss the importance of the evolution of PTSD from past DSM editions to the current one, and the implications of using the new diagnostic criteria and current conceptual models in the forensic evaluation of pediatric PTSD.

Exposure to trauma is a common event in the lives of children and adolescents living in the United States. Although a minority of youth develop full posttraumatic stress disorder (PTSD) after a traumatic event, those who do tend to have an extended course of symptoms in multiple functional domains and higher rates of psychiatric comorbidities. Pediatric PTSD can play an important role in legal settings, and requires that an expert witness be well versed in advances in clinical and conceptual models of this diagnosis and familiar with current research devoted to the posttraumatic response in youth. This review is designed to be a resource for the forensic evaluator and outlines the current understanding of epidemiological and clinical features of pediatric PTSD, as well as the neurobiological, dimensional, and developmental conceptual models that describe it.

Abstract There is a well-established and growing body of evidence from research that adolescents who commit crimes differ in many regards from their adult counterparts and are more susceptible to the negative effects of adjudication and incarceration in adult criminal justice systems. The age of criminal court jurisdiction in the United States has varied throughout history; yet, there are only two remaining states, New York and North Carolina, that continue to automatically charge 16 year olds as adults. This review traces the statutory history of juvenile justice in these two states with an emphasis on political and social factors that have contributed to their outlier status related to the age of criminal court jurisdiction. The neurobiological, psychological, and developmental aspects of the adolescent brain and personality, and how those issues relate both to a greater likelihood of rehabilitation in appropriate settings and to greater vulnerability in adult correctional facilities, are also reviewed. The importance of raising the age in New York and North Carolina not only lies in protecting incarcerated youths but also in preventing the associated stigma following release. Mental health practitioners are vital to the process of local and national juvenile justice reform. They can serve as experts on and advocates for appropriate mental health care and as experts on the adverse effects of the adult criminal justice system on adolescents.

Background: Despite numerous studies of diabetes mellitus type II (DM-II) in schizophrenia and schizoaffective disorder, there have been no studies on the glycemic effects of switching patients with long-standing symptomatic DM-II from their current antipsychotic regimen to ziprasidone. Methods: An open-label, prospective inpatient study was conducted with 26 suboptimally responding inpatients with DSM-IV diagnoses of schizophrenia or schizoaffective disorder and comorbid DM-II who were switched to ziprasidone monotherapy and followed for 8 weeks. Outcome measures were fasting glucose, triglycerides, cholesterol, insulin levels, capillary blood glucose levels and weight. After a 3-week cross-titration period, patients were treated with ziprasidone up to a dose of 320 mg daily. Results: Of the 26 study participants, 16 completed the entire study period of 63 days and 10 (38.46%) discontinued participation, primarily due to psychotic relapse. There was a statistically significant reduction in fasting glucose (F=4.43, p=0.05; 14.68 mg/dL mean reduction), capillary blood glucose levels (F=8.90, p=0.01; 25.36 mg/dL mean reduction), weight (F=4.46, p=0.05; 4.68 lb mean weight loss) and Body Mass Index (F=4.40, p=0.05; 3.62 kg/m2 mean reduction). There was also a reduction in the use of antidiabetic medications after the switch to ziprasidone. Nine (34.62%) patients met criteria for metabolic syndrome (MetS) at baseline, as compared to 4 (15.38%) at endpoint. No change was observed in positive symptoms (F=0.62, p=0.44), negative symptoms (F=1.47, p=0.24) and in total PANSS score (F=0.12, p=0.74). Conclusions: This study suggests significant improvement in metabolic side effects and MetS in the subset of the patients who were able to tolerate switching from a polypharmacy regimen to ziprasidone. There was a large discontinuation rate, which limited the sustained beneficial effects of ziprasidone. The decision to switch to ziprasidone in patients with prior suboptimal response has to balance the potential metabolic benefits and the potential relapse risks of the individual patient first and foremost