The Impact of Co-Occurring Mental Health Problems on Referral to and Initiation of Treatment Among Youth Under Probation Supervision

Many youth under community supervision have substance use (SU) problems and co-occurring mental health (MH) issues. Yet access to treatment is limited, and many programs cannot address co-occurring SU and MH disorders. This study examines how co-occurring disorders among youth on probation affect referral to and initiation of treatment. We hypothesize that both referral and initiation rates will be lower for youth with co-occurring disorders.

Administrative data were collected from 14 counties in three states between March 2014 and November 2017. Among 8,554 youth in need of treatment (screened as having a SU problem, drug possession arrest, positive drug test, etc.), 2,070 were referred to treatment and 1,630 initiated treatment. A co-occurring MH problem (n=2,830) was based on indicators of an internalizing or externalizing disorder. Descriptive analyses compared referral and initiation by MH status. Logistic regression models predicted referral and initiation, controlling for individual-level variables. Two-level mixed effects logistic regression models estimated effects of site-level variables.

Among youth in need with a MH indicator, 18.0% were referred to treatment, and of those referred, 64.6% initiated treatment. Comparatively, 27.3% and 83.3% of youth without a MH issue were referred and initiated treatment respectively. Multivariate models found that MH indicators significantly predicted lower referral (p=.002, OR .813) and were marginally significant in predicting lower initiation (p=.067, OR .789). Multilevel models will estimate effects of site-level variation on referral and initiation.

Youth with co-occurring SU and MH conditions had lower likelihood of referral to treatment and subsequent treatment initiation. Given the high prevalence of co-occurring disorders among youth on probation, these findings suggest a need to improve the identification of MH service needs and referral to treatment. Additionally, there may be a lack of community programs that can adequately treat youth with co-occurring MH and SU issues and reduce unmet service needs.