The Influence of Parent Expectations and Parent-Child Relationships on Mental Health in Asian American and White American Families

Previous studies have suggested that Asian parents’ high academic expectations can lead to negative mental health outcomes among Asian American youth. We explore this hypothesis by analyzing data collected in an affluent, suburban high school with a large Asian American population. We examine the relationships between parent expectations, students’ relationships with their parents, and mental health outcomes among Asian American (predominantly Indian American and Chinese American) and white youth. We find that the quality of parent-child relationships is associated with mental health outcomes and that the association between parent expectations and mental health outcomes is insignificant after controlling for these relationships. We discuss significant differences by race and gender. The findings presented expand our understanding of the influence of Asian parents. They suggest that focusing on improving parent-child relationships, as opposed to altering parents’ expectations, might lead to improved mental health outcomes for Asian American youth, particularly for those in affluent communities.     

Art as therapy: an effective way of promoting positive mental health?

The aim of this study is to evaluate the contribution that creative arts can play in promoting positive mental health and well-being. The research is based on a case study of an innovative art therapy programme delivered by a community-based mental health organisation in Northern Ireland, as part of a supported recovery programme. The study reported here explored the experiences and perceptions of the service users through in-depth interviews and focus groups. The art as therapy course was credited with improvements in self-esteem and self-confidence. It provided a safe space for reflection on mental health issues. Participants described the programme as cathartic and a springboard for engagement in a wide range of further projects. It is concluded that this type of project which addresses mental health issues in a supportive, positive, non-clinical environment can encourage and facilitate empowerment and recovery through accessible creative programmes. However, to date these programmes are time-limited, small-scale and marginal to the approach adopted by statutory service providers.     

Responsive engagement in mental health services for foster youth transitioning to adulthood

ABSTRACT

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and mentors were flexible and responsive to their individual needs and trusted their ability to make decisions. Supportive adults who honored their choices and collaborated in decision-making were also helpful. Engaging, empowering, and partnering with transition-age youth may increase the likelihood of positive mental health outcomes for this population, offering implications for family-centered, strengths-based practice.     

Social and Emotional Functioning of Older Asian American Adolescents

This study identified a constellation of psychosocial problems reported by older Asian American adolescents that was different from their Caucasian peers. When compared to 386 Caucasian American adolescents from the same community, Asian American students performed better academically and reported fewer delinquent behaviors. However, these Asian American youth reported higher levels of depressive symptomatology, withdrawn behavior, and social problems. They also perceived themselves more poorly and were more dissatisfied with their social support. These differences highlight the unique mental health needs of older Asian American youth. Practice recommendations are made that consider traditional Asian values and the role that family members can play in the development of effective treatment plans.     

Testing the Model Minority Stereotype: Youth Behaviors across Racial and Ethnic Groups

Using data from a large nationally representative sample of adolescents attending school, this study tests the stereotype that youth of Asian Pacific Islander ethnicity (API) are the model minority. The results suggest that, except for substance use, API American youth do not report fewer delinquent behaviors than white youth; in fact, API American youth report slightly higher numbers of aggressive offenses than white youth, and female API American youth report greater numbers of nonaggressive offenses than white female youth. Also, API American youth report higher rates of nonaggressive offenses and substance use than do black youth. The mental health and social service needs of API American youth are thus at least as great as those of white youth. The need for such services increases with the length of residency in the United States.     

Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions

At a time when there is increasing attention being given to systematically integrating the well-being of children with the goals of safety and permanence in child welfare, little is known about the psychosocial functioning of foster youth transitioning to adulthood from substitute care. This article systematically reviews 16 peer-reviewed articles and/or research reports to identify lifetime and past year prevalence rates of mental health disorders and service utilization. At ages 17 or 18, foster youth are 2 to 4 times more likely to suffer from lifetime and/or past year mental health disorders compared to transition aged youth in the general population. Findings show that mental health service use declines at ages when the prevalence rate of mental health disorders is peaking. The findings of this review suggest the need to focus future efforts in three main areas: 1) setting a common research agenda for the study of mental health and service use; 2) routine screening and empirically supported treatments; and 3) integration and planning between child and adult mental health service systems.     

Risk and protective factors for depression and substance use in an adolescent child welfare sample

Research on the mental health needs of maltreated youth in out-of-home care remains limited. The goal of the current study was to examine two common mental health concerns (i.e., depression, substance use) among 122 12-15 year olds in out-of-home placements. Specifically, we investigated potential risk and protective factors among socio-demographic, maltreatment, youth, family, and community variables. We relied on data collected through the AAR-C2, a Canadian needs assessment and outcome monitoring tool. Approximately 4 in 10 (39.2%) youth endorsed at least one mental health problem, which we defined as the youth scoring at least one standard deviation above the sample mean for the depression items and the youth indicating the presence of alcohol and/or substance use over the past year. Almost 1 in 10 (8.3%) reported struggling with both mental health issues. Results from logistic regressions indicated that adolescent females were at higher risk of experiencing depression than males, and increasing age was associated with increased risk for substance use. Turning to protective factors, results indicated that the greater the perceived quality of the youth-caregiver relationship, the lower the risk for mental health difficulties (i.e., depression, substance use). Moreover, participation in extracurricular activities appeared to protect youth against depression or substance use. Results imply that the youth-caregiver relationship and involvement in extracurricular activities are important areas to consider to promote the well-being of maltreated youth in out-of-home care.     

Lost in transition: Illicit substance use and services receipt among at-risk youth in the child welfare system

This study examined the use of mental health and substance abuse services among adolescents in the child welfare system (CWS) who reported use of illicit substances. 1004 adolescents age 11–15 years at baseline were followed for 5–7 years, over five waves of data collection. Shortly after the investigation for maltreatment (baseline), 69.1% of youths using illicit substances received mental health and/or substance abuse outpatient specialty services. By the last follow-up, during the transition to adulthood, only 21.5% of young adults using illicit substances received outpatient specialty services. Youth who used illicit substances were more likely to receive outpatient and inpatient specialty services than non-users at the time of contact with the CWS (mostly baseline), but this difference faded over the follow-up period. By 5–7 years follow-up, there was no significant difference in specialty services receipt for illicit substances users versus non-users. Predictors of outpatient service use at most waves were having Medicaid, mental health needs, and having recently seen a school counselor or primary care physician. Among illicit substance users transitioning to adulthood, African American youths were less likely to receive outpatient specialty services than White youths. These findings reveal a need for more attention to illicit substances use among youth in the CWS, better cross agency integration, and special attention to the needs of transition-age youth to better connect them with services as they age out of the CWS.     

Parent-adolescent concordance on perceived need for mental health services and its impact on service use

Mental health service underutilization among African American adolescents is well documented, yet not fully understood. Discordance between adolescents and their parents on perceived need for seeing a counselor for an emotional need or psychiatrist for psychiatric or medical services may help explain low service use among this population. This exploratory, prospective study examined the relationship between parent-adolescent concordance on perceived need for emotional counseling or psychiatric services and mental health service use. The relationships between gender and perceived service need and concordance and adolescent severity of depressive symptoms were also explored. Parent-adolescent dyads (n = 108) receiving community-based adolescent outpatient mental health services responded to interview questions concerning their perception of whether an emotional counselor and a psychiatrist were needed in the past six months. Findings revealed low parent-adolescent concordance on perceived need for an emotional counselor and a psychiatrist. A greater proportion of adolescents reported a need than parents. There was no association between gender and perceived need for an emotional counselor and a psychiatrist. Lower rates of parent-adolescent concordance were found among youth reporting elevated depressive symptoms compared to youth reporting normal range symptoms. Concordant dyads kept a higher number of appointments than discordant dyads. Implications for clinical social work practice and future research are discussed.     

Juvenile justice,mental health,and the transition to adulthood: A review of service system involvement and unmet needs in the U.S.

Although adolescents are the primary focus of juvenile justice, a significant number of young people involved with this system are considered transition age youth (i.e., 16–25 years of age). The aims of this review are to summarize the specific needs of transition age youth with mental health conditions involved with the juvenile justice system, identify the multiple service systems relevant to this group, and offer recommendations for policies and practice. A comprehensive search strategy was used to identify and synthesize the literature. Findings highlight the paucity of research specific to transition age youth. Thus, we also summarized relevant research on justice-involved adolescents, with a focus evaluating its potential relevance in the context of the unique milestones of the transition age, including finishing one's education, setting and working towards vocational goals, and transitioning from one's family of origin to more independent living situations. Existing programs and initiatives relevant to transition age youth with mental health conditions are highlighted, and nine specific recommendations for policy and practice are offered.     

Behavioral health correlates of exposure to community violence among African-American adolescents in Chicago

AimsThough public health researchers are more aware of behavioral health concerns among African American youth, few studies have explored how exposure to community violence may be related to adverse youth concerns. This study examines the relationship between exposure to community violence and mental health problems, substance use, school engagement, juvenile justice involvement, and STI risk behaviors.MethodsA total of 638 African American adolescents living in predominantly low-income, urban communities participated in the study by completing self-report measures on exposure to community violence, mental health, school engagement proxies, substance use, delinquency markers and sexual risk behaviors.ResultsAdolescents who reported higher rates of exposure to community violence were significantly more likely to report poorer mental health, delinquent behaviors, a history of juvenile justice involvement, lower school bonding and student-teacher connectedness. These youth were also significantly more likely to use alcohol, cigarettes, and illicit substances, and engage in sexual risk behaviors.ConclusionsFindings suggest that there is a critical need for culturally relevant prevention and intervention efforts for African American adolescents who are frequently exposed to community violence.     

Substance abuse among Asian American youth: An ecological review of the literature

The purpose of this review is to understand the risk and protective factors that are associated with substance use among Asian American youth. Using the Bronfenbrenner's (1994) ecological systems theory, we examine how individual characteristics (age, gender, psychopathology, genetics, and ethnic differences), micro- (family and peers), meso-/exo- (relations between family and peers, cultural norms, and economic stress), macro- (academic achievement and cultural influences), and chrono-systems (acculturation) level factors influence or inhibit substance use among Asian American youth. In addition, this review highlights major implications for practice and policy to prevent substance misuse and to improve outcomes for substance abusing Asian American youth.     

Racial/Ethnic Differences in Court Referred Pathways to Mental Health Services for Children in Foster Care

Racial/Ethnic disparity in placement patterns and service utilization among children in foster care has been documented in a variety of studies. This study examined the role of the court process in referring children in foster care to mental health services and tested for racial/ethnic differences in the patterns of referral and service use. Court records for 142 children ages 2–16, representing Caucasian, African American, and Hispanic racial/ethnic groups were reviewed. Results indicate that the court process does play a significant role in referring children to services. Significant differences by race and ethnicity in mental health service utilization prior to the child's protective placement, as well as service orders, and post-placement service use were identified. Caucasian youth were more likely to receive orders for psychotherapy and to have documented use of psychotherapy than were African American and Hispanic youth, even when the possible confounding effects of age and type of maltreatment were controlled. Implications for the effective delivery of supportive services to those children most in need are discussed.     

Parent–child relationships,friendship networks,and developmental outcomes of economically disadvantaged youth in Hong Kong

This research investigates factors conducive to the thriving of economically disadvantaged young people in Hong Kong. In particular, we examine ways in which the parent–child relationship and friendship networks, as the principal sources of support during the transition from childhood to adulthood, influence the developmental outcomes of this group of young people with regard to their mental health, positive identity, behavioral adjustment, resilience and academic achievement. Based on a survey of 479 young people recruited from community-based youth-service centers located in different districts of Hong Kong, the results of the present research support the hypotheses that parent–child relationships and friendship networks have significant positive effects on youth development among low-income young people. Our results also show that, when compared with friendship networks, the parent–child relationship is a stronger predictor of youth development, that is, a stronger parent–child relationship tends to correspond to a better developmental outcome. Moreover, our research provides empirical evidence regarding the influence that parents can have on shaping the quality of young people's friendship networks. The implications of our findings, both for future research and for service delivery to promote the well-being of economically disadvantaged young people, are discussed.     

Latent classes of older foster youth: Prospective associations with outcomes and exits from the foster care system during the transition to adulthood

Youth in the foster care system face considerable challenges during the transition to adulthood. However, there is significant variability within this population. This study uses person-oriented methods and a longitudinal dataset of youth aging out of foster care to examine differences in how subgroups of foster youth fare during the transition to adulthood. We identified four distinct latent classes, consistent with prior person-oriented studies of this population, and validated these classes by examining differences on additional relevant factors at age 17. After establishing these classes, we tested their predictive validity by examining differences in outcomes at age 19 in domains relevant to the transition to adulthood, including education and employment, problem behaviors, and mental health problems. Finally, given the importance of extended foster care in promoting better outcomes, we used survival analysis to prospectively examine whether class membership was associated with differences in the rates at which youth left foster care between ages 17 and 19. One large group of youth exhibited moderate behavior problems and left care quickly, while another large group of resilient youth had favorable outcomes and left care relatively slowly. A small group exhibited considerable behavior and mental health problems, but left care more slowly, and a very small group was characterized by a history of pregnancy. Findings suggest considerable variability in service need among older foster youth. Implications for service provision during the transition to adulthood are discussed.     

Perception of Substance Use Problems in Asian American Communities by Chinese,Indian, and Vietnamese American Youth

SUMMARY

The study was a cross-sectional survey using a convenience sample of 87 Asian American youth respondents to examine their perceptions of substance use problems in the Asian American community. The authors examined respondents' perceptions of the severity of substance use problems in the Asian American community, perceived characteristics of persons with problems of substance use, perceived etiology of substance use problems, beliefs about treatment, perceived help-seeking preferences and helpful services. The youth demonstrated an increased awareness of the severity of substance use problems in the community, although such awareness was more prominent for drinking problems than drug use problems. Respondents showed a positive attitude toward treatment, although such an attitudinal change was not yet accompanied by a change in their behavioral preferences. Findings suggested a tendency for Asian American youth respondents to utilize personal resources rather than professional help or formal treatment programs in response to substance use problems. In addition, respondents shared similar “myths” of Asian problem drinkers and drug users. Implications for developing culturally relevant interventions for prevention and treatment as well as future research are discussed.     

Race and ethnic differences in depressed mood following the transition from high school

Young adulthood is a period of increased mental health risk, with evidence linking psychological disorder to problematic role transitions. To our knowledge, there has been little or no research that examines the forces shaping minority mental health at this time. Using a diverse, urban sample of young adults who are followed over a two-year period, this paper examines the link between race/ethnicity and depressed mood and the transitional roles and interpersonal experiences that mediate this association. Findings indicate that blacks and Hispanics have elevated depressed mood relative to whites and Asian Americans, independent of socioeconomic background factors. The underrepresentation of blacks and Hispanics in four-year colleges largely explains the differences in depressed mood between members of these groups and Asian American youth. In contrast, comparisons of black and Hispanic youth to white youth highlight problems in peer and parental relations among individuals in the former groups. Overall, findings suggest that the heightened depressed mood among Hispanics and blacks relative to whites and Asian Americans reflects their increasingly disadvantaged pathways into adulthood, characterized by poorer prospects for educational advancement and more problematic relationships subsequent to the high school years.     

Step-Up: Promoting Youth Mental Health and Development in Inner-City High Schools

African American and Latino youth who reside in inner-city communities are at heightened risk for compromised mental health, as their neighborhoods are too often associated with serious stressors, including elevated rates of poverty, substance abuse, community violence, as well as scarce youth-supportive resources, and mental health care options. Many aspects of disadvantaged urban contexts have the potential to thwart successful youth development. Adolescents with elevated mental health needs may experience impaired judgment, poor problem-solving skills, and conflictual interpersonal relationships, resulting in unsafe sexual behavior and drug use. However, mental health services are frequently avoided by urban adolescents who could gain substantial benefit from care. Thus, the development of culturally sensitive, contextually relevant and effective services for urban, low-income African American and Latino adolescents is critical. Given the complexity of the mental health and social needs of urban youth, novel approaches to service delivery may need to consider individual (i.e., motivation to succeed in the future), family (i.e., adult support within and outside of the family), and community-level (i.e., work and school opportunities) clinical components. Step-Up, a high school-based mental health service delivery model has been developed to bolster key family, youth and school processes related to youth mental health and positive youth development. Step-Up (1) intervenes with urban minority adolescents across inner-city ecological domains; (2) addresses multiple levels (school, family and community) in order to target youth mental health difficulties; and (3) provides opportunities for increasing youth social problem-solving and life skills. Further, Step-Up integrates existing theory-driven, evidence-based interventions. This article describes Step-Up clinical goals, theoretical influences, as well as components and key features, and presents preliminary data on youth engagement for two cohorts of students.     

The essential dialogue: a Norwegian study of art communication in mental health care

This study focuses on how semi-structured art dialogues can be used to communicate with older patients with impaired mental health. The study was conducted on a geropsychiatric ward at a university hospital in Norway. To communicate with the patients via works of art, health professionals used semi-structured art dialogues; data were collected by qualitative methods. The findings are based on verbatim quotations regarding the health professionals' experiences of their communication with the patients. Two main categories were identified: the physical domain and the caring domain. Dialogues about figurative as well as nonfigurative art forms were found to stimulate and evoke memories; for some patients, these dialogues were an essential step in creating well-being as well as more-being.     

Former system youth with mental health needs: Routes to adult mental health care, insight, emotions, and mistrust

Objective

Public health concern surrounding the mental health needs of former system youth is escalating. We know very little about mental health service utilization on the other side of the developmental transition to adulthood. The purpose of this study was to explore the mental health service use experiences among former system youth with childhood histories which included mental disorder, use of publicly-funded mental health services, and use of additional public systems of care.

Methods

In-depth face-to-face interviews were conducted with 60 participants currently struggling with mental health difficulties regarding their service use experiences over the transition. Participants were recruited from one Midwestern state. Multi-phase analysis was conducted utilizing immersion/crystallization, constant comparison and concept matrices.

Results

Few participants received continuous mental health care across the transition, with the majority experiencing interruptions or discontinuation of care. Important facilitators of service use emerged, such as physicians, former caseworkers and family. Health clinics and parenting programs emerged as potential entrée points for reconnecting disengaged young adults to mental health services. Insight, mistrust, and emotions emerged as novel factors associated with service utilization among young adults.

Conclusions

Mental health service utilization remains a complicated phenomenon over the developmental transition to adulthood. Future research is needed that closely examines the associations between insight, emotion, mistrust and service use among young adults.