(PS7-32) Caregiver-reported Facilitators and Barriers to Youth Behavioral Health Treatment Among Youth with Juvenile Legal System Involvement: Differences by Types of Mental Health Concerns

Abstract Text:

Background: Juvenile legal system-involved youth (JLIY) face barriers to behavioral health (BH) treatment even after BH needs are identified (Belenko et.al., 2018). Further, caregivers’ perceptions of youths' needs dictate youth treatment pathways (Cause et.al., 2002.) In non-JLIY, internalizing psychopathology is linked with caregiver and youth readiness for treatment (Djurovic et al., 2025). However, it remains unclear whether different psychopathology types are associated with caregiver-level treatment barriers and facilitators among JLIY. The present study used a sample of JLIY to: (a) identify clusters of youth by different psychopathological presentation; and (b) examine differences in caregiver-reported motivation for treatment, treatment barriers, and youth services engagement by cluster.

Methods: The current sample includes caregivers (N=100; 85% female) of youth recruited from a juvenile court diversion program with identified BH concerns. Caregivers completed measures of: youth externalizing and internalizing concerns (Pediatric Symptoms Checklist; Jellinek & Murphy, 1988), current number of BH services (Child and Adolescent Services Assessment; Burns et.al., 2008), readiness for treatment and problem recognition (Motivation for Youths Treatment Scale; Breda & Riemer, 2012) and number of barriers to treatment (Barriers to Treatment Participation Scale; Kazdin et al., 1997). K-means cluster analysis identified clusters of youth by caregiver-reported internalizing and externalizing symptoms. Next, one-way ANOVAs were used to examine differences in number of current services, number of treatment barriers, readiness for treatment, and problem recognition across clusters.

Results: K-means cluster analysis revealed 3-clusters: ‘Low Psychopathology’ (LP; n=42) ‘Subclinical Psychopathology' (SP; n=24) and 'High Internalizing & Sub-clinical Externalizing Psychopathology' (HIP; n=24). Significant differences emerged in problem recognition, with HIP scoring higher than LP and SP (p < .001). LP differed significantly from HIP and SP in treatment readiness and number of services (p < .001, p <.001). SP differed non-significantly from SP and HIP in total barriers to treatment (p < .067).

Discussion: In a sample of JLIY with identified BH concerns, our results revealed three caregiver-reported youth mental health clusters, including one with clinically elevated internalizing concerns. High internalizing concerns were significantly associated with caregiver problem recognition. In contrast to previous findings on non-JLIY, caregiver readiness for treatment did not differ between subthreshold and clinically significant internalizing groups. These results may offer insight into causes of treatment disparities for JLIY and point to caregiver readiness for treatment as a critical dimension of caregiver-level barriers to treatment. This has implications for improving access to treatment for JLS-involved youth.