Barriers to Behavioral Health Treatment among Youth and Caregivers Involved in the Juvenile Legal System

Between 50-70% of youth involved in the juvenile legal system meet criteria for at least one psychiatric condition. To address this mental health crisis, juvenile diversion programs often screen youth for behavioral health conditions and refer them to providers. However, only a small proportion of youth in need of treatment initiate care during or after their involvement with the system.

The primary aim of this mixed methods study was to identify perceived barriers to treatment participation among caregiver-youth dyads involved in a court diversion program. We examined caregiver and youth demographic characteristics, behavioral health, and legal system factors associated with greater levels of treatment barriers.

We conducted surveys, interviews, and reviewed administrative court records for 100 caregivers and youth in a juvenile court diversion program in a northeastern state (July 2023-May 2024). Procedures were approved by the health system-affiliated IRB.

Caregivers reported an average of four barriers to treatment participation. The most common barriers included youth resistance to treatment and scheduling conflicts. Bivariate and multivariate analyses showed that caregivers from minoritized racial backgrounds, with lower income or education, and those with Hispanic/Latinè-identifying youth reported higher perceived barriers. Qualitative findings echoed these results, and additionally highlighted barriers including mistrust of court-affiliated services, long waitlists, limited provider availability, and a strong caregiver preference for culturally matched, community-based services.

Our results indicate that while caregivers are motivated to get their child into treatment, they face several different types of barriers to service engagement. These findings underscore the need for acceptable, accessible and family-centered behavioral health service pathways.