Youths entering the juvenile justice system are often identified as needing help for substance use and mental health concerns, yet very few—only one in ten—receive needed behavioral health services, according to a new study in Psychiatric Services, a journal of the American Psychiatric Association.

This lack of treatment can contribute to worsening substance use and mental health problems and to further involvement in the justice system. Juveniles with substance use disorders are nine times more likely than youths without them to be involved in the justice system, the authors note. Early intervention can help.

Researchers, led by Gail A. Wasserman, Ph.D., with Columbia University and New York State Psychiatric Institute, examined rates of substance use screening, identification of substance use treatment needs, and referral to and initiation of treatment among youths (under age 18) entering the juvenile justice system. The study looked at the often-complex series of steps in the process from screening, to referral, to starting service, to ongoing engagement and continuing care, and where youth may be falling through.

They reviewed data on more than 8,300 youths from 33 community justice agencies in seven states. Participating community justice agencies are part of the Juvenile Justice–Translational Research on Interventions for Adolescents in the Legal System funded by the National Institute on Drug Abuse.

The researchers found that more than 70% of youths in the systems were screened for substance use problems and other behavioral health concerns. The rates of screening varied significantly among the justice agencies, ranging from 7% to 100%.

The two factors associated with higher levels of screening were youth under higher supervision by the community justice agency and youth charged with a substance-related offense. A higher supervision level included ongoing formal oversight by probation, parole, or juvenile drug court officials. A lower level of supervision refers to diversion to community programs or placement on informal community supervision.

Among youth who were screened, more than half were identified as needing treatment. Among those in need, only about one in five were referred to treatment, and about two-thirds of those started treatment.

Those receiving higher levels of supervision were more than 2.5 times as likely to be identified as being in need of services and nearly five times as likely to be referred to treatment as those who were diverted or informally supervised.

The study found community justice agencies tend to focus more on youths’ legal history than behavioral health needs in their practices, although both unmet needs contribute to likelihood of future justice system involvement. “The failure to provide juveniles at lower levels of supervision with needed treatment referrals is worrisome,” the authors conclude, “given their high numbers and the value of these services in preventing further justice system involvement.” The authors encourage better coordination of interagency efforts in order to increase referrals for youth when needs have been identified.