For the past two decades, Linda Teplin has explored the lives (and deaths) of nearly 2,000 people who entered the US juvenile justice system as adolescents.
As the first large-scale longitudinal study of psychiatric disorders in delinquent youth, the research has resulted in startling discoveries on topics ranging from HIV/AIDS and recidivism to drug abuse and gun violence. Findings have shown that many adolescents who are detained — even when found innocent — lead adult lives plagued by violence, incarceration, and other social tribulations.
Now, the findings are informing a new set of groundbreaking intergenerational studies launched by a trio of grants from the Department of Justice (DOJ) and National Institutes of Health.
The new collective studies — the Northwestern Juvenile Project: Next Generation — will allow investigators to re-interview their original participants, now mostly in their 30s, and their adolescent children.
Another aspect of the new studies, one funded in January by the National Institute of Justice, will allow Teplin, the Owen L. Coon Professor of Psychiatry and Behavioral Sciences, to investigate a simple question: How does the parent’s involvement with firearms during their own adolescence (possession, ownership, victimization, perpetration) affect that of their child?
“Tragically, we found early on that many of our original participants died young, often from gunshot wounds,” says Teplin, director of Northwestern’s Health Disparities and Public Policy Program in the Department of Psychiatry and Behavioral Sciences. “Our new project allows us to examine intergenerational patterns of firearm violence. We never expected to study death rates in a sample so young, but six years after the Northwestern Juvenile Project began, so many of our kids had died that we wrote our first article on mortality, published in Pediatrics.”
By 2014, so many more research participants had died that the investigators wrote a second article in Pediatrics showing that, compared to the general population, males between age 15 and 19 were five times more likely to die, while females were nine times more likely to die.
“We often think of these youth as violent perpetrators, but they are likely to become victims,” says Teplin.
A grant funded in September by the Eunice Kennedy Shriver National Institute of Child Health and Human Development will increase the number of participants in the DOJ-funded research.
A second award — from the National Institute on Drug Abuse — funded in September will launch an intergenerational study of drug addiction and related health disparities.
Teplin became interested in incarcerated populations in the early 1980s. She found that people with psychiatric disorders were being arrested rather than treated because there were few alternatives. “The jail had become the poor person’s mental hospital,” she says.
Her research led her to become an expert on studying people who fall through the cracks of the mental health systems into the criminal justice net. “We addressed a critical omission: Most studies of correctional populations were conducted by criminologists, who focus almost entirely on recidivism. In contrast, we studied mental health.”
The idea for the Northwestern Juvenile Project came from Teplin’s epidemiologic studies of psychiatric disorders in adult jail detainees. “We found that many of our participants first developed symptoms of psychiatric disorders when they were kids — at about the same time when they entered the justice system,” she says. “For us, the logical next step was to study kids in detention.” That work began in 1995, as Teplin examined the mental health needs and long-term outcomes of youth after detention.
Teplin’s studies also address an oversight in NIH’s portfolio of longitudinal studies. She points out that longitudinal studies funded by NIH systematically underrepresent young African American males. The reason? Nearly all focus on community populations, and do not sample from correctional institutions. Moreover, the typical longitudinal study drops participants if they become incarcerated at follow-up. “The samples are thus biased because young African American males are disproportionately incarcerated. Our studies address this omission,” says Teplin.
The Northwestern Juvenile Project has systems in place to track every person in the study.
“Our first follow-up interviews took place three years after youth were in detention, and they occurred at a time when cell phones and the internet were still extremely rare,” said Karen Abram, psychiatry and behavioral sciences, an investigator on the Northwestern Juvenile Project, who developed the innovative methods needed to track and retain participants.
Researchers stayed in touch by sending participants birthday cards and gifts (returned mail meant they may have lost track of an individual), and eventually went door to door to find people, when necessary.
“We have talked with participants in an eighth floor apartment of a housing project with broken elevators; during a dancer’s dinner break at a gentleman’s club; and while parked in a garbage truck. We hit the streets for public health,” says Teplin. “Epidemiological studies need to retain as many people as possible. Otherwise, you lose the people who have the worst outcomes, which biases the findings.”
For the past 20 years, the project — sometimes staffed with 50 or 60 people — has conducted nearly 18,000 in-person interviews with 1,829 participants, first recruited when they entered the Cook County Temporary Juvenile Detention center in the late 1990s at 10 to 18 years of age.
“We included a diverse group of participants, including oversampling females, youth ages 10-13, and youth whose cases were processed in adult court. This allows us to understand their unique needs” said Abram, who has collaborated with Teplin for nearly 30 years.
In addition to publishing papers in high-impact professional journals, Northwestern Juvenile Project research has been cited in reports by the Surgeon General, used in amicus briefs to the Supreme Court, presented in congressional hearings, and widely disseminated by federal agencies and advocacy groups.
“Our findings don’t just sit on my coffee table. We effect change in public health policy nationwide,” says Teplin. “We are fortunate to conduct our studies here, where we have steadfast support from city, county, and state agencies.” Among the effects on juvenile justice, criminal justice, and public health policy, research findings have spurred the development of tools to screen and treat juvenile and adult detainees for psychiatric disorders, enhanced services for comorbid disorders, and improved programs for people at risk for victimization and suicide.
Many delinquent youth commit crimes because of untreated psychiatric disorders, Teplin has found. For example, they may use drugs to self-medicate for depression, and then sell drugs to afford them, she says.
Since it was officially launched with a 5-year award from the National Institute of Mental Health in 1998, the Northwestern Juvenile Project has received more than $50 million in funding from nearly 20 different federal agencies and private foundations. The newest research is supported by DOJ grant 2017-IJ-CX-0019, NIDA grant R01DA042082, and NICHD grant R01HD093935.
“Our investigations are somewhat unusual at Feinberg: Many public health researchers study patients, use household based samples, or study school populations,” says Teplin. “Few researchers study incarcerated populations. Yet, incarcerated populations are underserved, are disproportionately racial/ethnic minorities, and must be part of public health solutions.”