Substance Use, Mental Health, and Child Welfare Profiles of Juvenile Justice-Involved Commercially Sexually Exploited Youth

Abstract

Objectives: To describe the substance use profiles of youth impacted by commercial sexual exploitation (CSE) and explore associations between substance use with mental health diagnoses and child welfare involvement. Methods: Data were systematically extracted from the court files of 364 youth who participated between 2012 and 2016 in Los Angeles County's Succeeding Through Achievement and Resilience (STAR) Court, a juvenile delinquency specialty court for youth impacted by CSE. Descriptive statistics and multivariate regression analyses were conducted to quantify associations between youths' substance use with mental health diagnoses and child welfare involvement. Results: Of the 364 youth impacted by CSE involved in the STAR Court, 265 youth had documented contact with a psychiatrist while in court-of whom, 73% were diagnosed with at least one mental health challenge. Before STAR Court participation, 74% of youth were the subject of one or more child welfare referral; of these youth, 75% had prior out-of-home care. Eighty-eight percent of youth reported substance use, the most prevalent illicit substances were marijuana (87%), alcohol (54%), and methamphetamine (33%). Controlling for age and race, youth impacted by CSE with a diagnosed general mood disorder had more than five times the odds of reporting substance use compared with those without a mood disorder diagnosis (adjusted odds ratio [AOR]: 5.80; 95% confidence interval CI: 2.22-18.52; p < 0.001); and youth impacted by CSE with prior child welfare placements had more than two times the odds of reporting substance use (AOR: 2.24; 95% CI: 1.04-4.86; p = 0.039) compared with youth without prior placements. The association between substance use and general mood disorder was significant and positive for all substance use types (AOR = 3.3, p = 0.033 marijuana; AOR = 4.01, p = 0.011 concurrent alcohol and marijuana; AOR = 9.2, p < 0.001, polysubstance use). Conclusions: High prevalence of substance use among juvenile justice-involved youth impacted by CSE combined with strong associations between substance use with both mental health diagnoses and child welfare system history underscores the need for comprehensive, specialized substance use treatment. Findings suggest an important opportunity for multidisciplinary collaboration among mental health providers, child welfare professionals, juvenile justice practitioners, and other care providers for these youth.

A Balancing Act: How Professionals in the Foster Care System Balance the Harm of Intimate Partner Violence as Compared to the Harm of Child Removal

“…Based on the results of this research, it is clear that Los Angeles County’s CWS must be significantly reformed with regard to how it intervenes in cases of IPV. Many advocates and policymakers have recently proposed bringing together multidisciplinary teams to put forward policy changes, make child removal decisions, and evaluate child removal decisions (Bai et al, 2019 ; Bath et al, 2020 ; Herbert & Bromfield, 2019 ; Ogbonnaya & Keeney, 2018 ; Trubek & Farnham, 2000 ). Our study’s findings illuminate how each professional’s professional and legal duties influence their decision-making within the CWS.…”

Balancing clinical needs and probation requirements within CSEC specialty courts

“…Notably, one of the few CSEC specialty courts that has been examined empirically is the STAR (Succeed through Achievement and Resilience) Court in Los Angeles, CA (Bacharach et al, 2020). Data published on youth who have participated in this specialty court suggest that youth who have experienced exploitation have histories of adversity (e.g., child welfare involvement), educational concerns, and significant mental health and substance use issues (Bacharach et al, 2020; Bath et al, 2020a; Cook et al, 2018). Cook et al (2018) found relationships between substance use and mental health concerns, as well as substance use and histories of abuse, suggesting the need for trauma‐responsive behavioral health interventions.…”

Informal mentoring support as a potential moderator of the relation between adolescent dating violence victimization and substance use

“…Adopting a prevention perspective in this preliminary test of the protective role of informal mentor support, we used a broad index of adolescents' involvement in substance use rather than their use of specific substances. Thus, we asked participants to report their use of various substances but combined those reports to form a dichotomous variable indicating involvement or lack of involvement in substance use (Bath et al, 2020). We tested four hypotheses.…”