Differences in treatment trajectories between two profiles of adolescent systems involvement

Of adolescents utilizing behavioral health services, between 45% and 62% (Farmer et al., 2003; Merikangas et al., 2011) become involved in multiple systems (i.e., mental health, juvenile justice, child welfare, and education systems) to meet their behavioral health needs (e.g., Glisson & Green, 2006). Despite their involvement in treatment, these youths often still have unmet needs due to lack of integrated care across systems (e.g., Hawkins, 2009). Adolescent behavior problems may be conceptualized differently to account for the unique needs of youth involved in multiple systems. Using a sample of 433 youth in need of behavioral health treatment services, we: (1) identified distinct classes of systems involvement across four systems, (2) compared youth comprising these classes on demographics and DSM-IV diagnoses, and (3) examined changes in delinquency and substance use over time among the youth comprising the systems involvement class groupings. Using latent class analysis, we identified two distinct classes of adolescent systems involvement: one with heavy involvement in all systems and the other with high involvement in only the education and mental health systems. Latent growth curve analyses using most likely class membership as a predictor demonstrated that adolescents with heavy involvement in all systems showed significantly more decreases in delinquent activity than comparison youth, but less decreases in substance use over a one-year follow-up period. Our findings support that it is clinically useful to examine classes of multiple systems involvement. Treatment providers can use these findings identify whether or not their clients are heavily involved in all systems and tailor their approach accordingly. In addition, researchers can continue to parse out differences in treatment trajectories for multiple systems involved youth as well as the various factors impacting these differences.