Psychosis Screening in Juvenile Justice

Among adolescents in the Juvenile Justice System (JJS), an estimated 3% have a psychotic
illness, and it can be reasonably assumed that many more experience subthreshold
psychotic-spectrum symptoms that may be indicative of risk. Evidence suggests that as many as
25% of those with first episode psychosis (FEP) have their first contact with care through
criminal justice agencies. Duration of untreated psychosis (DUP), a negative prognostic
factor, has been shown to be longer among those within the criminal justice system. This
suggests that youth with psychotic symptoms who end up in the JJS may not receive appropriate
mental health care. This study will first track mental health referrals for JJ youth with
psychosis-spectrum symptoms in Phase 1, a standard care condition, and then an enhanced
referral and linkage to care model will be investigated in Phase 2 of the study.

The current study will be conducted in the Rhode Island Family Court Juvenile Intake
Department where all youth receive a mental health screen (Massachusetts Youth Screening
Instrument - 2nd Ed; MAYSI -2). All youth who screen positive on the MAYSI-2 Thought
Disturbance scale, and a second gate screening with the Prodromal Questionnaire - Brief
Version (PQ-B), will be given referral information for Coordinated Specialty Care (CSC)
services by JJS staff. Enrolled families will also participate in the research assessment,
regardless of whether they pursue the CSC referral, which involves the Structured Interview
for Psychosis-risk Syndromes [SIPS] and other measures to thoroughly assess history of
psychotic symptoms, comorbid difficulties, and mental health care engagement. A comparison
sample of youth who screen negative on the MAYSI-2 Thought Disturbance subscale will also be
assessed with the SIPS to determine accuracy of the MAYSI-2/PQ-B screen in the identification
of psychosis-risk. During the first phase of the study, JJS staff will follow standard
procedures in referring youth to the state CSC. In the second phase of the study, JJS will be
instructed in an enhanced referral/linkage to care protocol, including a "warm hand-off"
where referrals will be put in direct and immediate contact with CSC staff. CSC staff will
also be trained in procedures to increase the likelihood of follow through with the referral
to the CSC. Three month follow-up qualitative interviews and quantitative assessments
regarding referral pathways, bottlenecks and gaps in care, youth psychiatric symptoms, and
JJS contacts will be conducted. This design maps onto the stated goals of PAR 16- 264
including: 1) Identify baseline rates of DUP within the JJS (and the investigators will also
look at rates of psychosis-spectrum symptoms and disorders); 2) Map referral pathways to CSC;
3) Identify implementation and service level factors that create bottlenecks and gaps in
linkage to the CSC; 4) Investigate the relationship between treatment linkage and psychotic
symptoms/DUP; and, 5) Pilot test feasible strategies for reducing DUP.

Inclusion Criteria:

- Adolescent being seen in the Juvenile Justice System

- Legal guardian available to consent for juvenile's participation

- Adolescent assents to participate

- Adolescent is English speaking

- Parent/guardian may be English or Spanish-speaking

- Adolescent flags positive on the MAYSI-2 Thought Disturbance subscale or the PQ-B

Exclusion Criteria:

- Adolescent has observable developmental delays that would interfere with obtaining
assent and/or accurate assessment

- Adolescent meets hospital level of care for imminent risk due to severity of symptoms