The role of interagency collaboration in facilitating receipt of behavioral health services for youth involved with child welfare and juvenile justice

Unmet need for behavioral health care is a serious problem for crossover youth, or those simultaneously involved with the child welfare and juvenile justice systems. Although a large percentage of crossover youth are serious emotionally disturbed, relatively few receive necessary behavioral health services. Few studies have examined the role of interagency collaboration in facilitating behavioral health service access for crossover youth. This study examined associations for three dimensions of collaboration between local child welfare and juvenile justice agencies - jurisdiction, shared information systems, and overall connectivity - and youths' odds of receiving behavioral health services. Data were drawn from the National Survey of Child and Adolescent Well-Being, a national survey of families engaged with the child welfare system. Having a single agency accountable for youth care increased youth odds of receiving outpatient and inpatient behavioral health services. Inter-agency sharing of administrative data increased youth odds of inpatient behavioral health service receipt. Clarifying agency accountability and linking databases across sectors may improve service access for youth involved with both the child welfare and juvenile justice systems.     

Racial/ethnic disparities in prior mental health service use among incarcerated adolescents

Research on racial and ethnic disparities in mental health and substance abuse service use among incarcerated youth in the U.S. is inconclusive. This cross-sectional study adds to our understanding of racial and ethnic disparities by examining the prior use of mental health and substance abuse services among incarcerated juveniles. Guided by Andersen's behavioral model of health service utilization, a series of logistic regression analyses were conducted on a non-probability sample of 13–19 year-old youth in two residential facilities for juvenile offenders in Western Pennsylvania (N = 181). Black and Hispanic youth were less likely than White youth to have used mental health and substance abuse services, even when controlling for predisposing, enabling, and need factors. Additional analyses revealed that these differences did not hold across all service types, specifically with regards to outpatient service use. Significant differences did exist, however, in the prior use of inpatient mental health and substance abuse services. This suggests that White youth are often funneled into the mental health system, while youth of color enter the justice system. Implications for racial/ethnic disproportionality in service use and justice system involvement are discussed.     

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.     

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.     

Adolescents' Self-Reported Substance Risks and Need to Talk About Them in Mental Health Counseling

Summary

Although adolescents seeking mental health services may not consider them related, the prevalent co-morbidity of substance use and mental health problems makes it imperative that practitioners find ways of engaging troubled youth about substance issues. Based on their responses to a clinical self-assessment questionnaire (Adquest), this study shows that mental health service applicants are willing to disclose their substance use behaviors and are open to talking about them to intake workers. Age and gender differences in substance use patterns and willingness to talk are explored.     

What mental health professionals in Israel know and think about adolescent problem gambling

Mental health professionals are well versed in addressing multiple adolescent risky behaviours and play a primary role in the identification of and referral process and service provision for young people who engage in such behaviours. Given their ‘person-in-environment’ approach, training in multi-sectoral collaboration, and awareness of social policies, social workers are especially equipped to provide needed mental health services to young people. The aim of the current study was to examine Israeli mental health professionals’ awareness of and attitudes towards adolescent high-risk behaviours, including gambling. Child psychologists, social workers and school counsellors (N = 273) completed an online survey addressing concerns related to high-risk behaviours. Findings revealed that social workers perceived gambling as being among one of the least concerning adolescent mental health issues and reported feeling the least confident in their abilities to provide services to young people with gambling problems. The results suggest the importance of youth gambling addictions being incorporated into social work training curricula.     

Deficits in young men's knowledge about accessing sexual and reproductive health services

Objective: The current study aimed to examine (1) gender differences in college students' knowledge of sexual and reproductive health care (K-SRHC) service access points, and (2) the relationship between demographic and psychosocial factors and college students' overall K-SRHC service access points. Methods and Participants: Self-report online surveys were administered to 18- and 19-year-old college students from a northern California public university (N = 183; 39.9% men; 32.2% Latino). Results: Women reported higher overall K-SRHC service access point scores than men. Findings indicated that gender and family planning self-efficacy were the strongest correlates of K-SRHC service access points. Men with a regular source of health care had higher K-SRHC service access points than men without. Conclusions: Results suggest that college men need additional education about how to access sexual and reproductive health services to support their own and their partner's health.     

Fractured lives: understanding urban youth vulnerability in Perú

ABSTRACT

The paper reports on a mixed methods study that sought to analyse determinants of youth labour market and educational disengagement in Peru. It begins by questioning the widespread focus on NEET – youth not in employment, education or training – as a measure of youth vulnerability in countries with extensive informal labour markets where labour precarity can be as problematic as unemployment for young people’s futures. A broader category of ‘urban vulnerable’ youth, including both NEET and precarious workers, is proposed and used as the basis for analysing the factors that influence young people’s trajectories. Key factors and shocks in youth trajectories are identified through qualitative life histories, and are tested using cross-section and panel survey data. Findings from the study have implications for the analysis of youth labour market vulnerability in the Global South, as well as for the policies that seek to address this problem.     

Being a service user and a social work academic: balancing expert identities

Abstract

I am a service user and academic working in a university social work department. My hybrid identity allows me to draw on different types of knowledge in all aspects of my work, including: academic, practice and experiential wisdom. Service user involvement is mandated across social work education but the scope and breadth of different kinds of participation is developed in diverse ways across university contexts. This article affirms the value of service user involvement in health and social care education, exploring its positive impact on students. When lecturers share personal experience of using services alongside practice and academic wisdom in the course of teaching, sometimes the value of experiential knowledge is doubted and its influence dismissed. I examine the importance of experiential wisdom in social work education, specifically when it is embedded in an academic role in a university social work department, and consider how it can be respected and valued. The parallel experiences of involving peer support workers in mental health services, who use their knowledge of recovery to mentor other service users, are then briefly examined, together with reflection of the concerns across mental health with professionals sharing their experiential wisdom with the people that they support.     

Personal control and service connection as paths to improved mental health and exiting homelessness among severely marginalized homeless youth

ObjectiveNon-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes.MethodSeventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline.ResultsPersonal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health.ConclusionsThis study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

Men's Reproductive and Sexual Health

Abstract

A broad definition of men's reproductive and sexual health (MRSH) includes medical (pathophysiological) matters such as sexually transmitted infections (STIs), developmental anomalies, malignancy, trauma, and infertility. It also includes psychosocial concerns: sexuality, contraception, disease prophylaxis, developmental and lifecycle issues, tobacco and drug use, sexual identity and orientation, and partnership issues. College men, of whom a large majority are sexually active, have a range of MRSH needs, including some that are particular to their age and social environment. To reach men effectively requires approaches that are somewhat different from those used with women. Clinicians in college health services are in an excellent position to help young men recognize the importance of reproductive health and sexual responsibility. College health services therefore should offer men screening; clinical diagnosis and treatment for MRSH conditions; and information, education, and counseling services, in a manner designed to meet their unique needs.     

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.     

Use of Various Health Care Services by Students in Helsinki

Abstract

Review of the working of various health care schemes has revealed predominant use by a certain group of “large-scale consumers.” The concomitant use of various services (health, dental, and mental health care) was studied within the Helsinki Health Center of the Finnish Student Health Service from January 1, 1980 to August 31, 1980. The group consisted of 16,174 students. The characteristics of the groups of patients who used only the mental health care service and of those who used all three services were also studied. Within each sector, there were fewer patients than expected who did not use the services of other sectors. The number of patients visiting dental and health care services, mental health and health care services, and all three services were greater than expected. The groups of patients who used only the mental health care service and those who used all three services were surprisingly similar. The greatest difference between the groups probably lay in their need for somatic and dental care. The organization, which incorporates mental health, dental, and health care services in the same building offers improved possibilities for care of the patient as a whole. On the basis of this study, there is no reason to think that such an organization leads to misuse of the various services.     

Multiple Risks,Multiple Worries,and Adolescent Coping

Summary

To describe the process that clinicians use to engage vulnerable urban adolescents in mental health counseling, the authors propose a tri-partite model of clinical engagement that takes into account: (1) consumer preference; (2) risk and worry; and (3) youth development (YD) perspectives. These conceptual lenses embody what adolescents want to talk about, their exposure to behavioral and environmental risks, and their coping and strengths. Based on responses given by urban adolescents seeking mental health services to a clinical self-assessment questionnaire (Adquest), this paper uses this tripartite model to summarize patterns of risk that service applicants experience, what they worry about, and how they cope. It explores the substructure of adolescent risk and vulnerability, through factor analysis of relevant items across a broad range of Adquest life areas, to develop a typology of adolescents by risk and worry. Patterns of coping and desire to talk across a range of life areas within this typology are described, as are the practice implications. The authors conclude that even those adolescents who most concern clinicians—because they have high environmental and behavioral risk and low worry-present many different opportunities for engagement.     

Development and Utilization of a Practice-Based,Adolescent Intake Questionnaire (Adquest)

Summary

This article describes an intake questionnaire (Adquest) that was designed, tested, and implemented, and later employed in clinical data-mining studies, by practitioners in an adolescent mental health program. The instrument is primarily a practice-based, clinical information-gathering and client engagement device. Consequently, it differs in significant ways from more research-driven Rapid Assessment Instruments (RAIs). Despite these differences, when aggregated and analyzed, Adquest data provides valuable psychosocial information about hundreds of vulnerable urban youth seeking mental health services.     

Educational risk,recidivism, and service access among youth involved in both the child welfare and juvenile justice systems

Dually-involved youth represent a population of youth who receive some level of supervision from both the child welfare and juvenile justice systems concurrently. The current study examined education-related risk factors, recidivism, referrals for services, and service access among dually-involved youth in Los Angeles County. Specifically, whether increased educational risk was associated with referrals to, and access of, educational services and supports and whether higher receipt of educational services reduced recidivism approximately six months post-disposition. Data for this study consisted of a sample of dually-involved youth (N = 131) who were adjudicated delinquent and also had a child welfare case open. An Educational Risk Index (ERI) was developed and included school attendance, credit deficiency, problem school behavior, and current grades. Results indicate that educational risk was negatively associated with mental health services accessed, demonstrating that those with higher educational risk accessed less mental health services. Educational risk, however, was not associated with increased educational service referrals or access, suggesting a possible mismatch in educational need and service referrals. Lastly, there were no significant differences between those that recidivated and those that did not recidivate in service access and educational risk.     

Identifying Male College Students' Perceived Health Needs,Barriers to Seeking Help,and Recommendations to Help Men Adopt Healthier Lifestyles

Abstract

Seven focus groups at a university campus were formed to identify college men's health concerns, barriers to seeking help, and recommendations to help college men adopt healthier lifestyles. Content analysis was used to identify and organize primary patterns in the focus-group data. Results of the study revealed that the college men were aware that they had important health needs but took little action to address them. The participants identified both physical and emotional health concerns. Alcohol and substance abuse were rated as the most important issues for men. The greatest barrier to seeking services was the men's socialization to be independent and conceal vulnerability. The most frequently mentioned suggestions for helping men adopt healthier lifestyles were offering health classes, providing health information call-in service, and developing a men's center. Implications of the results are discussed.     

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.