Journal of Health Care for the Poor and Underserved

248 Brief commu nication TO PRISONS OR HOSPITALS: RACE AND REFERRALS IN JUVENILE JUSTICE To the editor: Felton Earls [Vol. 2, No. 1:156-164] suggests that racial bias and discrimination within juvenile justice as well as police, mental health, and social welfare systems are impediments to the provision of appropriate services to minority youth. A number of studies have documented that black children and adolescents are found more frequently in facilities for delinquents than in facilities for the mentally disturbed.1"3 Willis-Fredman3 also found that more restrictive settings tend to have a higher percentage of males, adolescents, and nonwhites. These studies lend credence to the belief that placement decisions for children and adolescents are influenced by the racial characteristics of youth being considered for placement. In a recent study4, we examined the characteristics of youth placed in a psychiatric hospital and a corrections facility. The purpose of the investigation was to determine whether youth in the two settings differed by demographic characteristics or by the degree or type of emotional/behavioral disturbance. The study included all children age 12 to 15 who were admitted between January and June 1989 to a psychiatric hospital for children and adolescents and a juvenile corrections facility, both operated by the state, in Richmond, Virginia. Thirty-two families (42 percent of eligible families) with children admitted to the hospital, and 38 families (38 percent of eligible families) with children admitted to the corrections facility agreed to participate in the study. Caretakers were asked to complete a brief demographic questionnaire and aChild Behavior Checklist (CBCL).5 The demographic questionnaire generated information about age, gender, race, family structure, previous placement, and parents' occupation. The CBCL provided summary scores for social competence and total problems as well as separate scores for internalizing problems (e.g., sadness, anxiety, somaticizing (converting feelings to physical disorders)) and externalizing problems (fighting, delinquency, swearing). Consistent with studies cited above, we found that blacks were overrepresented in the corrections sample; 63 percent of children in the corrections sample were blacks, compared to 34 percent in the hospital sample. Overall, there were no significant differences in CBCL scores between the Journal of Health Care for the Poor and Underserved, Vol. 2, No. 2, Fall 1991 ____________________________________________________________249 corrections and hospital samples. The mean scores for children in both settings fell within the clinical range. At first blush, our finding of differential referrals by race suggested that black youth with serious emotional disorders were more likely to be placed in corrections than were white youth with similar problems. But further analysis revealed an unanticipated profile: whites in corrections facilities were more disturbed than blacks. Using analysis of variance, we found a significant sitetimes -race interaction for total behavioral problems (f=7.29, df=l, p<0.009), with white children in corrections having higher problem scores than blacks in corrections. White children in corrections also scored significantly higher than black children in that setting on the internalizing scale (p<0.0007) and the externalizing scale (p<0.002). Among hospitalized youth, there were no significant differences between whites and blacks in scores for either total behavioral problems or the internalizing or externalizing scales. While the small size of the sample and the absence of a comprehensive assessment of the youngsters limit our ability to draw valid inferences from these findings, the results of this study do raise questions about racial determinants of placement of children, as well as the appropriateness of treatment and service in relation to their needs. Although it seems that children with emotional and behavioral problems had access to a psychiatric hospital regardless of race, there are still concerns about why there is an overrepresentation of blacks in the corrections setting. In addition, the high level of pathology for white children in corrections suggests that authorities may use a higher threshold for admission for white children. Why are youth with such severe mental health problems placed in a corrections facility? Are the emotional and behavioral problems of white children in corrections so difficult that other providers have not been able to serve them, so that they end up in corrections as a placement of last resort? There is some support for this hypothesis: 42 percent of the 1,306 youths admitted to correctional facilities in Virginia in 1989 were white, yet whites accounted for 71 percent of the youths who had previous psychiatric hospitalizations (D. Waite, personal communication). Although our research does not directly confirm Dr. Earls' contention of differential referral to treatment according to race, it certainly suggests that many of the children who are committed to corrections facilities appear to have serious unmet treatment needs and raises questions about the systems' apparent inability to provide appropriate services to meet these needs. —Robert Cohen, Ph.D. Director Virginia Treatment Center for Children Division of Child and Adolescent Psychiatry Medical College of Virginia MCV Station, Box 489 Richmond, Virginia 23298-0489 250 REFERENCES Friedman RM, Kutash K. Mad, bad, sad, can't add? Florida Adolescent and Child Treatment Study (FACTS). Unpublished manuscript. Tampa: Florida Mental Health Institute, University of South Florida, 1986. Westendorp F, Brink KL, Roberson NK, et al. Variables which differentiate placement of adolescents into juvenile justice or mental health systems. Adolescence 1986 Spring;21 (81 ):2437 . Willis-Fredman M. The Kentucky child profile. Frankfort, KY: Department for Mental Health and Mental Retardation Services, 1988. Cohen R, Pannelee DX, Irwin L, et al. Characteristics of children and adolescents in a psychiatric hospital and a corrections facility. J Am Acad Child Adolesc Psychiatry 1990 Nov;29(6):909-13. Achenback TM, Edelbrock CS. Manual for the Child Behavior Checklist and revised child behavior profile. Burlington, VT: University Associates in Psychiatry, 1983. ...