Differences in stigma and punishment beliefs among community mental health center and juvenile justice personnel: a qualitative approach

Adolescents with substance use disorders (SUDs) in the juvenile justice (JJ) system often have unmet treatment needs. JJ and community mental health centers (CMHCs) are frequently misaligned, and stigma and punishment beliefs towards adolescents with SUDs ultimately shape their care across these systems. We aimed to evaluate differences in stigma and punishment beliefs among JJ and CMHC personnel through qualitative interviews. Data were drawn from a stepped-wedge, cluster-randomized hybrid type II effectiveness-implementation study conducted in a Midwestern state to improve JJ-involved youth access to substance use treatment. In total, 65 unique JJ and CMHC staff completed qualitative interviews (N = 92). Qualitative interviews explored perspectives on stigma and punishment and were thematically coded by trained researchers. Qualitative findings illustrated persistent tensions between CMHC and JJ personnel regarding their respective roles and expectations in engaging youth in treatment. Participants described differing perspectives on youth needs and engagement, as well as stigma and the role of juvenile justice in punitive approaches. These findings suggest that improving collaboration alone may not be sufficient. Our findings point to the need for intentional, evidence-based strategies that go beyond coordination to directly address provider attitudes and reduce stigma toward JJ-involved adolescents with SUDs.