In 1982, Jane Knitzer famously reported that two-thirds of youth with serious mental health challenges were either underserved or unnecessarily institutionalized (Knitzer, 1982). In the decades since, home-based interventions for these youth and their families have emerged as viable treatment options (Stroul & Friedman, 1986;Love, Mueller, Tolman & Powell, 2014; DHHS 2005; ACA II, §2402 ( 2010)). These intensive programs occupy a critical point in the continuum of care: they represent the threshold between community retention and institutional placement. As of 1999, 35 states offered some form of intensive, home-based treatment (IHBT) for children and youth with psychiatric impairments, and research pursuant to this review found

There is growing support for the disaggregation of psychopathy into primary and secondary variants. The present study used latent profile analysis to distinguish psychopathic variants in a sample of male and female adolescent detainees (N = 162). Youth were classified by their scores on the self-report Triarchic Psychopathy Measure, indexing trait Boldness, Meanness, and Disinhibition, as well as measures of anxiety and guilt. Four groups were found, two of which were nonpsychopathic. Consistent with theory, however, two distinct classes of youth scoring high on psychopathic traits were identified: a primary variant with below-average levels of anxiety and guilt and a secondary variant with markedly above-average levels. Youth in the latter category also presented with the highest levels of psychopathology within the detainee sample. The ratio of males to females was 2:1 within the low-anxious psychopathy variant, and it was 1:2 in the high-anxious psychopathy variant. Implications for identification and treatment of adolescent psychopathic variants are discussed.

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