# Reducing the Duration of Untreated Illness Among Youth in the Juvenile Justice System with Psychosis-Spectrum Disorders

> **NIH NIH R34** · BROWN UNIVERSITY · 2020 · $243,395

## Abstract

Project Summary
Among adolescents in the Juvenile Justice System (JJS), an estimated 3% have a psychotic
illness, and it can be reasonably assumed that many more experience subthreshold psychotic-
spectrum symptoms that may be indicative of risk. Evidence suggests that as many as 25% of
those with first episode psychosis (FEP) have their first contact with care through criminal
justice agencies. Duration of untreated psychosis (DUP), a negative prognostic factor, has been
shown to be longer among those within the criminal justice system. This suggests that youth
with psychotic symptoms who end up in the JJS may not receive appropriate mental health
care. The current study will be conducted in the Rhode Island Family Court Juvenile Intake
Department where all youth receive a mental health screen (Massachusetts Youth Screening
Instrument – 2nd Ed; MAYSI -2). All youth who screen positive on the MAYSI-2 Thought
Disturbance scale, and a second gate screening with the Prodromal Questionnaire – Brief
Version (PQ-B), will be given referral information for Coordinated Specialty Care (CSC) services
by JJS staff. Enrolled families will also participate in the research assessment, regardless of
whether they pursue the CSC referral, which involves the Structured Interview for Psychosis-risk
Syndromes [SIPS] and other measures to thoroughly assess history of psychotic symptoms,
comorbid difficulties, and mental health care engagement. A comparison sample of youth who
screen negative on the MAYSI-2 Thought Disturbance subscale will also be assessed with the
SIPS to determine accuracy of the MAYSI-2/PQ-B screen in the identification of psychosis-risk.
During the first phase of the study, JJS staff will follow standard procedures in referring youth to
the state CSC. In the second phase of the study, JJS will be instructed in an enhanced
referral/linkage to care protocol, including a “warm hand-off” where referrals will be put in direct
and immediate contact with CSC staff. CSC staff will also be trained in procedures to increase
the likelihood of follow through with the referral to the CSC. Three month follow-up qualitative
interviews and quantitative assessments regarding referral pathways, bottlenecks and gaps in
care, youth psychiatric symptoms, and JJS contacts will be conducted. This design maps onto
the stated goals of PAR 16- 264 including: 1) Identify baseline rates of DUP within the JJS (and
we will also look at rates of psychosis-spectrum symptoms and disorders); 2) Map referral
pathways to CSC; 3) Identify implementation and service level factors that create bottlenecks
and gaps in linkage to the CSC; 4) Investigate the relationship between treatment linkage and
psychotic symptoms/DUP; and, 5) Pilot test feasible strategies for reducing DUP.

## Key facts

- **NIH application ID:** 9971582
- **Project number:** 5R34MH115457-03
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Anthony Spirito
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $243,395
- **Award type:** 5
- **Project period:** 2018-08-15 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9971582

## Citation

> US National Institutes of Health, RePORTER application 9971582, Reducing the Duration of Untreated Illness Among Youth in the Juvenile Justice System with Psychosis-Spectrum Disorders (5R34MH115457-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9971582. Licensed CC0.

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