(PS13-D83) Psychosis-risk Screening in a Juvenile Justice Setting: Efforts to Enhance Early Identification Among High-risk Adolescents

Among individuals with psychosis, a substantial proportion report experiencing clinically significant positive psychosis-spectrum (PS) symptoms (e.g., hallucinations or delusions) prior to age 18. This suggests that adolescence may be a critical period to screen for PS experiences and employ secondary prevention efforts. Research indicates that 50-75% of youth in the juvenile justice system (JJS) meet criteria for mental health disorders and many are not engaged in treatment. An estimated 3% of adolescents in the JJS have a psychotic illness, and it can be reasonably assumed that many more experience subthreshold PS symptoms that may be indicative of risk. Thus, efforts to screen for mental health symptoms, including PS experiences, may be important for justice-involved youth to promote linkage to appropriate care. This study explores the occurrence of PS symptoms within a JJS setting and examines the performance of two screening measures in identifying those who meet criteria for a PS diagnosis.

Upon intake to the Family Court, adolescents (aged 12-18) completed the Massachusetts Youth Screening Inventory- 2 (MAYSI-2), a self-report mental health inventory designed for the JJS. Adolescents and caregivers were then offered the opportunity to take part in a research protocol that included the Prodromal Questionnaire- Brief (PQ-B) to screen for PS experiences and a diagnostic interview including the Structured Interview for Psychosis-risk Syndromes (SIPS). The MAYSI-2 Thought Disturbance (TD) and PQ-B scores were explored in relation to PS symptoms and diagnoses. The TD scale includes 5 items scored yes (1) or no (0) and the PQ-B includes 21 items scored from 0 (absent) to 5 (strongly agree that the experience is distressing or impairing). Receiver operating characteristic (ROC) curve analyses examined the accuracy of each screening tool in identifying adolescents meeting SIPS criteria for a PS diagnosis.

A total of 156 youth completed the assessment (mean age = 14.76; 54.5% male), and 16% (n = 25) met SIPS criteria for a PS diagnosis. TD and PQ-B scores were positively correlated with PS diagnosis (r = .32 and .48, respectively). All 21 PQ-B items and 4 of 5 TD items were positively correlated with PS diagnosis. ROC curve analyses indicated that the optimal cutoffs for maximizing accuracy in identifying those meeting criteria for PS diagnoses were a score of 1 or more on the TD scale and a score of 14 or more on the PQ-B. The TD cutoff of 1 performed as follows: sensitivity = 70.83, specificity = 57.27, overall accuracy = 59.70. The PQ-B cutoff of 14 performed as follows: sensitivity = 83.33, specificity = 80.67, overall accuracy = 81.11.

Both screening tools performed adequately to identify adolescents in this JJS setting who met criteria for a PS diagnosis. The relative strengths and weaknesses of each screening tool will be discussed. Overall, results suggest that screening for PS symptoms in the JJS is warranted, and follow-up assessment may facilitate early identification of youth experiencing clinically significant PS symptoms.