4 - (SYM 63) The Landscape of Randomized Controlled Trials for Behavioral Health-focused Psychosocial Interventions for Youth in the Juvenile Legal System: A Systematic Review

Background. Youth in the juvenile legal system (JLS) exhibit high rates of behavioral health concerns beyond conduct problems, including PTSD and depression (Beaudry et al., 2021). Over the past several decades, policymakers and researchers alike have called for the development and evaluation of efficacious behavioral health interventions for youth with JLS involvement. Thus, the present study provided a systematic review between the years of 1990 and 2024 of randomized controlled trials (RCTs) of community-based psychosocial interventions focused on behavioral health among JLS-involved youth. This review also sought to characterize the number of studies conducted, types of interventions tested, and the frequency of different types of primary outcomes (e.g., conduct problems, internalizing concerns), as well as the quality of RCTs.

Method. A systematic search of articles published between January 1, 1990 and June 30, 2024 was conducted across several databases. The initial literature search yielded 6,173 articles and 2,422 remained after de-deduplication. Ultimately, 286 remained after screening for irrelevance. Full-text screening of articles was then conducted and, ultimately, 51 articles remained. To conduct a quality appraisal assessment of included studies, we used the Mixed Methods Appraisal Tool for RCTs (Hong, 2018). Finally, independent coders extracted the following for each article: study characteristics (e.g., location), participating characteristics (e.g., race), intervention characteristics (e.g., modality), and outcome characteristics (e.g., type of outcome studied).

Results. Fifty one studies from 38 unique RCTs were published over a 33.5 year period, with an average of 1.52 studies published annually. The majority of studies were published in the 21^st century (76.5%), with the most studies being published in 2012 and 2014 (n = 4 for each year). Family-focused interventions were most frequently tested (63.2%) and the most commonly studied outcomes were delinquency and conduct problems (58.8%), followed by alcohol and substance use (27.5%). Psychosis spectrum (2.0%) and trauma-related concerns (0.0%) were the outcome of interest least often studied.

Implications. There was a dearth of RCTs focused on the behavioral health of youth in the JLS published in the past 33.5 years. It seems imperative to scale up the number of RCTs conducted with this population, with a focus on both system diversion and ameliorating behavioral health concerns.