Intervening to address communication difficulties in incarcerated youth: A Phase 1 clinical trial

Exploration of how youth justice staff perceive the speech-language pathology role and service provision in an Australian youth justice setting

PURPOSE

The aims of this project were to explore how youth justice staff perceive the speech-language pathology role and provision in an Australian youth justice setting, including the speech-language pathologist's role in supporting young people to participate in the activities of the youth justice service studied.

METHOD

A narrative inquiry approach was employed to guide semi-structured interviews with youth justice staff. Perceptions and experiences were analysed via reflexive thematic analysis, with member checking and inter-rater coding utilised for rigour.

RESULT

Seven semi-structured interviews were conducted. Interviewees worked in either the custodial setting (n = 3) or the community setting (n = 4) for the youth justice service studied, though most had worked in both settings. Six themes and six subthemes were identified from the interview data and related to factors that supported improved participation in the activities of the youth justice service studied. These factors were the speech-language pathology skillset and approach, and that there were systemic barriers within the service. All participants perceived speech-language pathology input as valuable for the young people in the service studied. There was also acknowledgement by the participants of how speech, language, and communication needs of the young people impacted their participation in the activities of the service studied. These findings were despite the perceived need for organisation-wide education on the speech-language pathologist role and offering.

CONCLUSION

Increased understanding of how youth justice staff perceive the role and benefits of speech-language pathology in supporting young people in contact with the youth justice system will assist with service planning, inform education strategies, and may support policy change.

Reimagining From Abroad: Speech-Language Pathologists as Interprofessional Partners Supporting Justice-Involved Youth in America

PURPOSE

With application to the United States, this tutorial explores barriers in the American juvenile justice system for justice-involved youth (JIY) with cognitive-communication disorders (CCDs). It outlines models from abroad and reimagines the American juvenile justice system to include speech-language pathologists (SLPs) as interprofessional practice partners.

METHOD

Interprofessional (i.e., criminal justice, speech-language pathology) literature from the United States and overseas is reviewed and summarized to explain the American juvenile justice system, outline areas of concern for youth with CCDs, and describe potential solutions.

RESULTS

The application of speech-language pathology services within the juvenile justice system is explained and visually depicted. This framework was informed by intervention models and approaches from international examples.

CONCLUSIONS

There is an opportunity to embed speech-language pathology services from intake into court action and through disposition for JIY with cognitive-communication impairments. This includes interprofessional education and development, SLPs providing direct intervention, and multidisciplinary screening efforts. Speech-language pathologists as interprofessional advocates and practice partners can improve life chances and outcomes for youth with CCDs in the juvenile justice system.

Exploring the Cognitive-Communication Challenges of Adults With Histories of Traumatic Brain Injury and Criminal Justice System Involvement: A Pilot Study

INTRODUCTION

The prevalence of traumatic brain injury (TBI) in the criminal justice system (CJS) is well known. Furthermore, the impact of TBI on communication has been well documented; however, no study has explored the communication challenges of those with TBI in the CJS or considered their implications within CJS contexts. Moreover, no study has examined the possible differences in communication between those with TBI and CJS history and those with TBI but no CJS history.

PURPOSE

This cross-sectional pilot study provides a preliminary exploration of the cognitive-communication challenges in a sample of adults with histories of TBI and CJS involvement compared with a sample of adults with histories of TBI but no CJS involvement.

METHOD

Eight individuals with histories of TBI and CJS involvement were recruited through community agencies. The La Trobe Communication Questionnaire (LCQ) was administered to collect self-reported data on perceived cognitive-communication abilities, including social communication behaviors. Findings were examined and then compared with a previously studied sample of 160 individuals with TBI. Logistic regressions were calculated to determine whether response scores on the LCQ would be predictive of group membership (i.e., TBI + CJS or TBI only).

RESULTS

A range of cognitive-communication challenges were reported by both groups. A logistic regression analysis demonstrated a reasonable inference that LCQ responses may predict group membership and support the potential for statistically significant and meaningful results to justify future studies.

CONCLUSIONS

These challenges have the potential to negatively impact the success of communication interactions within the CJS and illustrate a need for speech-language pathology services for individuals with TBI in the CJS. The nature and magnitude of between-group differences merits further investigation with larger samples to explore whether any specific cognitive-communication challenge is unique to, or predictive of, CJS involvement for purposes of targeted assessment and intervention.

Speech-language pathologists' perspectives of communication strategies for young people in the New Zealand youth justice system

Purpose: Working in the justice system is a new and emerging area for speech-language pathologists (SLPs) in New Zealand, both in practice and research. This study explored SLPs' perspectives on: (1) the importance of implementing communication strategies in the New Zealand youth justice system, and (2) the effectiveness and relevance of the strategies employed.Method: A qualitative Phenomenology of Practice research approach was used. Five SLPs working as communication assistants in the New Zealand youth justice system were recruited through non-probability convenience sampling. Semi-structured interviews were conducted face-to-face or via video conference; these were audio recorded, transcribed, and analysed through an inductive coding process.Result: SLPs' perspectives on the importance of implementing strategies revealed two global themes: Complexities within Communication and Giving Young People a Voice. SLPs' perspectives on the effectiveness and relevance of the strategies used resulted in one global theme: SLP Role Goes Beyond Implementing Communication Strategies Alone.Conclusion: SLPs identified the need for their presence in the justice system due to the complexity of the environment. Participants perceived the current communication strategies were effective in equipping other professionals with skills to communicate with young people who offend. Recommended improvements to further assist young people's understanding were suggested.

Language disorder and internalizing mental health problems in youth offenders: A systematic review

BACKGROUND

The prevalence of language disorder in youth offenders far exceeds rates reported in community samples. Youth involved in the justice system are also at increased risk of a range of psychiatric disorders, including internalizing mental health problems (i.e., anxiety, depression). However, the frequency with which these co-occur in this population is not known. Understanding the co-occurrence of language disorder with anxiety and depression in youth offenders may contribute to more coordinated and targeted support for these vulnerable youth.

AIMS

To explore the co-occurrence of language disorder and anxiety and depression in youth offenders.

METHODS & PROCEDURES

A systematic literature search of six databases (CINAHL, ERIC, Medline, PyscINFO, PubMED, Scopus) was conducted (September 2021) using key search terms relevant to the systematic review question. Study inclusion criteria were: (1) original research published in English; (2) youth up to 21 years of age involved in the justice system; and (3) reported outcomes on language and anxiety and/or depression. All included studies were appraised using the Joanna Briggs Critical Appraisal tool checklist relevant to study design. Due to the heterogeneity of included studies, data synthesis was narrative.

MAIN CONTRIBUTION

Eight studies met the eligibility criteria. A range of measures was used to assess language abilities across samples. Only two studies directly addressed the relationship between language disorder and internalizing mental health problems; both found no significant correlation.

CONCLUSIONS & IMPLICATIONS

Although the results did not support a significant relationship between language disorder and internalizing mental health problems in youth offenders, the two appear to occur comorbidly as evidenced by heightened rates of both in the included samples. This review highlights the need for more robust studies aimed to better understand this relationship. Stronger evidence may contribute to increased collaborative speech pathology and psychology services which might increase youth offenders' accessibility and engagement in intervention programmes (e.g., cognitive-behaviour therapy; interpersonal skills training; individual counselling).

WHAT THIS PAPER ADDS

What is already known on this subject The markedly high rates of language disorder in youth involved in the justice system have been widely reported. It is also known that externalizing mental health problems often bring youth in contact with the justice system. Though there is some information about the prevalence of internalizing mental health problems in this population, the co-occurrence of language disorder and internalizing mental health problems has not been examined as widely. What this study adds to existing knowledge This study aimed to identify the frequency of co-occurrence of language disorder and anxiety and/or depression in youth offenders. Although the results did not support a significant relationship between language disorder and internalizing mental health problems in this population, results of the review provide evidence of heightened rates of both. This study also provides a summary of the various measures used to assess language and internalizing mental health in youth offenders across the eight studies included in this review. What are the potential or actual clinical implications of this work? It is possible that the tests and sub-tests used to identify language disorders and internalizing mental health problems were not sensitive enough to identify the full extent of youth offenders' needs. Identifying the presence of language disorders and internalizing mental health problems and recognizing the impact these may have on the communication and behaviours of an individual can better inform staff and therapists as they engage and interact with youth in the justice system.

A Systematic Review and Meta-Analysis of the Language Skills of Youth Offenders

PURPOSE

This systematic review and meta-analysis estimates the overall language skills of youth offenders involved with the juvenile justice system. Given the importance of this population, identifying avenues through which we can increase the likelihood of successful interventions is a necessary societal effort.

METHOD

Eighteen studies, representing data from 3,304 individuals, contributed 82 effect sizes to the current analytic sample. We used random-effects models to estimate the overall mean effect size metric to address each research question and fit meta-regression models for each moderator analysis.

RESULTS

Results yielded that youth offenders presented with significantly lower language skills than their nonoffending peers (g = -1.26). Furthermore, high proportions of the present meta-analytic sample were classified as youth with moderate (50%) and severe (10%) language disorders. In general, differences in language skills did not vary as a function of age, gender, or language measure type. We did detect significant differences as a function of sample country and type of peer comparison group.

CONCLUSIONS

This meta-analysis reports on the significantly compromised language skills of youth offenders. We conclude with a discussion of the findings and consideration of the implications for research and practice.

Interactions with youth justice and associated costs for young people with speech, language and communication needs

BACKGROUND

Individuals with speech, language and communication needs (SLCN) are at greater risk of contact with the criminal justice system. Diagnosis and appropriate treatment of SLCN reduces these risks, leading to better life outcomes for the individual as well as broader social and economic benefits. These youth represent a particularly high-priority group for research into language deficits, as the juvenile justice system involves situations with a high risk or serious consequences that rely upon the application of effective language skills. Whilst some studies have established some gains in speech and communication from speech pathology (SP) interventions during custody, there is limited evidence on the long-term impact of these gains following release from custody. Similarly, few studies have directly measured the cost savings associated with early SP on subsequent youth antisocial behaviour and crime.

AIMS

To estimate the youth antisocial behaviours, youth justice (YJ) contacts and associated costs (from a justice perspective) of childhood SLCN.

METHODS & PROCEDURES

Using 12 years of data from a longitudinal study of Australian children and young people, we employ a panel fixed-effects model to explore the relationship between SLCN and youth antisocial behaviour and youth offending between 12 and 17 years of age. Using these results, we estimate the cost of SLCN and subsequent cost savings associated with identification of SLCN.

OUTCOMES & RESULTS

The results showed that the annual cost of SLCN to the YJ system (exchange rate as at 9 December 2020) is A$875 (95% confidence interval (CI) = A$195, A$1916) (US$$649, €536, £485) per person who participates in youth crime, which is due to higher rates of youth antisocial behaviour and youth offending. Identification of SLCN (defined by SP treatment) appears to have a positive impact on youth antisocial behaviour and crime, mediated through improved language and communication. On average, young people with a history of 'identified' SLCN incur A$188 (95% CI = A$42, A$412) lower YJ costs (US$$140, €105, £115), compared with the same individual, before identification. Over the lifetime of the individual, this equates to A$9.2 million (95% CI = A$2.05 million, A$20.2 million) (US$$6.8 million, €5.6 million, £5.1 million) cost savings to the YJ system (A$3389 per person with SLCN) (2020 Australian dollars) (US$2513, €2074, £1880).

CONCLUSIONS & IMPLICATIONS

Overall, the findings revealed that young people with SLCN have an elevated risk of youth antisocial behaviour and crime. However, the identification of SLCN (and subsequent treatment) leads to changes in the offending risk trajectory for these individuals, resulting in lower rates of youth antisocial behaviour and consequently lower rates of crime and its associated justice costs.

WHAT THIS PAPER ADDS

What is already known on the subject It is well documented in the literature that young people in contact with the justice system have much higher rates of previously undiagnosed SLCN than those of the general population. There is less known about whether the identification of SLCN (and subsequent treatment) leads to changes in the offending risk trajectory for these individuals, leading to lower rates of youth antisocial behaviours and crime. What this paper adds to existing knowledge This study uses a longitudinal survey of 5000 children and young people to track the antisocial behaviour and crime-risk trajectory of children and young people with SLCN. The study finds evidence that young people with 'identified' SLCN report less juvenile antisocial behaviour and lower YJ contacts after intervention. The potential lifetime cost savings associated with intervention is A$9.2 million (95% CI = A$2.05 million, A$20.1 million) (US$$6.8 million, €5.6 million, £5.1 million). What are the potential or actual clinical implications of this work? The findings of this study can quantify the effects (in terms of cost savings to the justice system) of the early identification and subsequent intervention for young people with SLCN.

The oral language and reading comprehension skills of adolescents in flexible learning programmes

Purpose: Access to flexible learning programmes (FLPs) for students who have been excluded or diverted from mainstream school settings is increasing internationally. While still technically "engaged with education" such students face long-term vulnerability with respect to acquiring marketable employment skills post-school. Language and literacy skills are central to such training; hence, this study describes the oral language and reading comprehension profiles of a sample of flexible learning programmes (FLP) students.Method: Fifty young people (mean age 16 years) enrolled in three FLPs in Victoria, Australia were assessed by a speech-language pathologist in order to profile their oral language and reading comprehension skills.Result: Seventy-two percent of participants had oral language skills that placed them in an at-risk range on standardised measures, and 47.5% had reading comprehension ages of ≤12 years. A moderate significant association existed between oral language and reading comprehension skills.Conclusion: Language and reading comprehension difficulties are prevalent in this population and may be missed in the context of the mental health and adjustment difficulties experienced by this group, but are likely to be key to academic engagement and success. Speech-language pathology scope of practice needs to include FLP settings.

Speech and language therapy for adolescents in youth justice: A series of empirical single-case studies

BACKGROUND

Adolescents in contact with youth justice are a vulnerable and marginalized group at high risk of developmental language disorder (DLD) and other communication difficulties. Though preliminary studies have demonstrated the benefits of speech and language therapy (SLT) services in youth justice, limited research has empirically tested the efficacy of intervention in these settings.

AIMS

To evaluate the extent to which intensive, one-to-one language intervention improved the communication skills of incarcerated adolescents with below-average (> 1 SD below the mean) language and/or literacy skills.

METHODS & PROCEDURES

A series of four empirical single case studies was conducted, using multiple baseline intervention design. Individualized intervention programmes were administered, and progress on outcome measures (probes) was evaluated throughout the baseline, intervention and maintenance phases using Tau-U, a non-parametric distribution-free statistic. Additional measures were used as secondary outcomes of the intervention, including standardized language subtests, subjective rating tools by participants and their teachers collected pre- and post-intervention, and a brief structured participant interview, independently administered by youth justice staff.

OUTCOMES & RESULTS

Medium-to-large effect sizes, the majority of which were statistically significant, were detected on the primary outcome measure across the four cases, indicating improvements in the targeted communication skills. Positive results were also evident in comparisons of pre- and post-measures on standardized language subtests, subjective self- and teacher ratings of communication, and the participants' impressions of the interventions. For those participants who could be followed up, gains in language skills were generally maintained at 1 month post-intervention.

CONCLUSIONS & IMPLICATIONS

This study provides further evidence of the efficacy of one-to-one SLT intervention for adolescents in youth justice in order to address language and literacy difficulties. These findings inform future SLT service provision for adolescents in these settings, with clear policy and practice implications. Future research should investigate the wider benefits to individuals' engagement in youth justice intervention and recidivism, as well as assessing maintenance of gains over a longer period. What this paper adds What is already known on this subject The high rates of DLD in youth justice is well known, with difficulties spanning multiple areas of language and literacy. SLTs are increasingly working in community and custodial youth justice settings, and a few preliminary studies have demonstrated the effectiveness of such work. What this paper adds to existing knowledge This study extends the evidence base of the efficacy of SLT for language and literacy difficulties in youth justice, using a series of four empirical single case studies. It is also argued that SLT should be more actively considered in planning multidisciplinary interventions for young people in custody. What are the potential or actual clinical implications of this work? The results of this research support current moves to include SLT services in youth justice systems, and illustrate for clinicians currently working in this sector a way of structuring and measuring the impact of intervention services.

Speech-Language Pathology and the Youth Offender: Epidemiological Overview and Roadmap for Future Speech-Language Pathology Research and Scope of Practice

Purpose

This article is concerned with the growing body of international evidence indicating that adolescents in contact with the youth justice system are likely to have severely compromised oral language skills, receptively and expressively. A smaller, but persuasive, literature also points to poor literacy skills in this population. Language and literacy skills underpin academic, social, and vocational success ( C. Snow, 1983 ; P. C. Snow, 2016 ; Snowling & Hulme, 2012 ) and are central to the professional expertise of speech-language pathology as a profession ( P. C. Snow, 2016 ).

Method

In this article, I review the epidemiology of youth offending together with research evidence concerning the language and literacy skills of this population. I outline the major practice and research implications of these findings for speech-language pathology as a profession, considering the “school-to-prison pipeline” via key domains of early years' reading instruction, young people's passage through the justice system, restorative justice processes, and design and delivery of language and literacy interventions for young people on youth justice orders.

Results

Implications for speech-language pathology scope of practice and future research are outlined.

Conclusions

Speech-language pathology as a profession has a significant role to play in advocating for vulnerable young people at each point in the school-to-prison pipeline. This includes strengthening the evidence base concerning speech-language pathology language and literacy interventions and lobbying governments to fund speech-language pathology services to address the complex communication needs of this population, both on community-based and custodial orders.

Language diversity, language disorder, and fetal alcohol spectrum disorder among youth sentenced to detention in Western Australia

BACKGROUND

While studies confirm high prevalence of language disorder among justice-involved young people, little is known about the impact of Fetal Alcohol Spectrum Disorder (FASD) on language among this population. It is also not clear how language skills vary according to language diversity in Australian youth justice settings, where a disproportionate number of justice-involved youth are Aboriginal and may not speak Standard Australian English (SAE) as their first language. Language skills are important to understand, as language disorder and language difference can lead to a mismatch between the communication skills of a young person and the communication skills of the justice workforce with whom they are communicating. In the highly verbal environments that are common to justice systems, language disorder and language difference may result in a young person misunderstanding legal information and expectations placed on them and not being adequately understood by the justice workforce.

METHODS

This study examined the language skills of 98 young people sentenced to detention in Western Australia (WA), who participated in a cross-sectional study examining the prevalence of FASD. Language skills assessed using standardised and non-standardised tasks were analysed by the three major language groups identified: speakers of SAE, Aboriginal English and English as an additional language.

RESULTS

We identified rich diversity of languages, and multilingualism was common. Most young people for whom English was not their first language demonstrated difficulties in SAE competence. Further, nearly one in two young people were identified with language disorder - over half of whom had language disorder associated with FASD.

CONCLUSIONS

This study has documented language diversity and the prevalence of language disorder associated with FASD among a representative sample of youth sentenced to detention in WA. Results underscore the need for the justice workforce to consider language difference when working with justice-involved youth, as well as language disorder and FASD. The findings also demonstrate the need for speech pathology to be embedded as core service in youth justice systems, working in collaboration with local cultural and language advisors and accredited interpreters. This can better enable appropriate identification of and response to communication and associated rehabilitation needs of young people navigating youth justice systems.

Speech-language pathology intervention in a youth justice setting: Benefits perceived by staff extend beyond communication

PURPOSE

Young people in youth justice (YJ) settings face high-risk for unidentified language disorder, however, speech-language pathology (SLP) services are not routinely offered in such settings. The aim of this study was to explore and describe the perceptions and experiences of YJ staff in a custodial centre of the utility of having a speech-language pathologist working with young offenders.

METHOD

Following a SLP intervention trial, two staff focus groups were conducted by an independent SLP. Interview probes were developed through review of the literature and consultation with the practitioner who conducted the clinical intervention. Focus groups were digitally recorded for thematic analysis, which was carried out by the three authors independently.

RESULT

YJ staff expressed consistently positive views about the SLP intervention trial in their centre. Staff indicated that they learnt a great deal about the complexity of communication difficulties in this population, and that this information informed and guided their own practices. They expressed surprise at the engagement of young people in the SLP service, and supported its embedding in the YJ setting.

CONCLUSION

YJ staff endorsed the value of a SLP service in a custodial setting. Further research should focus on refining measurement of this service and its impact.

Language impairment and comorbid vulnerabilities among young people in custody

BACKGROUND

While the prevalence of language and communication difficulties among young people in custody is well established, holistic understanding of the complexity and co-occurrence of additional vulnerabilities among this population are rare.

METHODS

Ninety-three young people in a young offenders institution in England were assessed using the Comprehensive Health Assessment Tool, the Test of Word Knowledge, and a range of additional assessments of communication, cognition, and neurodevelopmental difficulties.

RESULTS

Forty-seven percent of the young people demonstrated an aspect of language skills significantly below the population average, with more than one in four identified as having impairment. Only one in four of those with an impairment had previously accessed speech and language services. Language needs were associated with difficulties with social communication and nonverbal cognition, as well as higher risk of self-harm and substance misuse.

CONCLUSIONS

Earlier identification of language difficulties requires routine assessment of young people at risk of engagement in offending behavior. Where language difficulties are identified, holistic assessments of needs should be undertaken. There is a need for speech and language therapy provision within youth justice services, as well as in other services accessed by young people at risk of engagement in offending.