Predicting Retention in Three Substance Abuse Treatment Modalities Among Anglo,African American,and Mexican American Juvenile Offenders

Abstract

Many of the same factors that predict delinquent behavior also predict adolescent drug use. This study examined factors that predict, and interventions that maximize, substance abuse treatment retention in three modalities among high-risk Anglo, Mexican American, and African American juvenile offenders. The study sample includes youth (N = 211) who were discharged from probation supervision and who received substance abuse services through a CSAT-funded federal demonstration project. The key predictors examined included the stage-of-change (i.e., precontemplation, contemplation, preparation) in which a juvenile fell, various dimensions captured by the Comprehensive Addiction Severity Index for Adolescents, and other intervention status (probation, case management, and mental health treatment). The research questions were addressed using statistical models known as survival analysis that treated time from entry into substance abuse treatment to exit from substance abuse treatment as the outcomes. Among key findings were that females were 73% more likely to leave day treatment relative to males; for each additional family problem ever experienced, Mexican American adolescents were 15% more likely to leave residential treatment compared with African American adolescents; and African American and Mexican American adolescents in the contemplation stage-of-change were 50% less likely to leave day treatment compared with Anglo adolescents. Applications for practice and research with this population are discussed.     

Trajectory and Predictors of Early Adolescent Alcohol Use

The aim of this study was to identify the developmental trajectory and predictors of Korean early adolescents’ alcohol use. The sample comprised 2844 adolescents who participated in the five‐wave longitudinal Korea Youth Panel Study, in which students were assessed annually from grade 4 (aged 11 years) in 2004 to grade 8 (aged 15 years) in 2008. Latent growth curve (LGC) modeling was conducted and a quadratic (J‐shaped) LGC model was supported. Personality‐ and environment‐system predictors, based on problem‐behavior theory, were specified to account for variation in intra‐individual changes in alcohol use. Self‐control, depressive affect, parental abuse, number of drinking friends, and gender significantly predicted the initial level of alcohol use. Self‐control, depressive affect, parental abuse, peer attachment, gender, and family structure predicted the quadratic slope that was associated with the rate of acceleration of alcohol use. These findings suggest that more effort needs to be directed toward the implementation of alcohol prevention programs early in elementary schools and practitioners who are involved in effective alcohol‐prevention and intervention programs that are aimed at delaying the initiation of alcohol use and reducing drinking during adolescence should consider various psychosocial factors.     

A case study on a generalist service delivery model for street children in Durban,South Africa: Insights from the capability approach

This paper adopts a qualitative case study on the generalist service delivery model of I‐Care, a Durban‐based non‐governmental organization that works with male street children. Fifteen face‐to‐face interviews were conducted with 10 I‐Care employees and 5 former street children. A focus group was set up with I‐Care employees. Although existing literature is forthright about a generalist approach for children at risk, it remains unclear how to implement this approach in practice. This paper reviews a continuity of 5 fundamental social work practices for working with street children: (a) outreach work, (b) child–family and child–community mediation, (c) transitory care centres and programmes, (d) brokerage, and (e) mentorship and follow‐ups. The study analyses how these practices contribute to the capability and agency expansion of the street children and outlines challenges that service providers and former street children experience. The main challenges acknowledged are balancing between the agency and protection of street children and the adaptation of children to street life. The study proposes intervention strategies to overcome these challenges.     

An explorative study of peer influence and response to adolescent self‐cutting behavior in Hong Kong∗

This paper reports on a qualitative study of peer responses to self‐cutting of secondary school adolescents in Hong Kong. Through semi‐structured in‐depth interviews with three adolescent self‐cutters, their family members, and their peers, the peers’ response to adolescents’ self‐cutting was explored. The findings showed that different peers had different types of influence, as well as different responses to self‐cutting. Close and supportive peers were usually the first to discover the self‐cutting. They were a source of help, communicating with parents, friends, teachers, and the adolescents themselves. In contrast, non‐supportive peers, especially boyfriends or girlfriends, created conflicts that seemed to provoke self‐cutting. The findings’ significance for social work intervention is also discussed.     

An Ecological Systems Comparison Between Homeless Sexual Minority Youths and Homeless Heterosexual Youths

ABSTRACT

This study examined risk and protective outcomes by comparing homeless sexual minority youths to heterosexual homeless youths regarding family, peer behaviors, school, mental health, stigma, discrimination, substance use, and sexual risk behaviors. Structured interviews (N = 147) were conducted with individuals aged 16 to 24 years old in Toronto. Bivariate analyses indicated statistically significant differences between homeless sexual minorities (n = 66) and their heterosexual counterparts (n = 81) regarding all variables: family, peer behaviors, stigma, discrimination, mental health, substance use, and sexual risk behaviors, with the exception of school belonging. Implications for future research are suggested.     

Dignity‐based practices in Norwegian activation work

This qualitative study sought to identify dignity‐based practices in a Norwegian activation programme ? the Qualification Programme. Some welfare recipients are likely to experience shame in connection with their interaction with the welfare system. Previous research suggests that a dignity‐based approach could help welfare recipients to avoid such negative experiences. The operational components of dignity have been identified as autonomy, empathy and rights. Data gathered through individual interviews with participants and activation workers were examined using interpretative phenomenological analysis with a focus on exploring respondents’ perceptions of events to which they ascribe meaning. The findings indicate that accounts of empathy were common, but that the study’s participants seldom reported experiencing that their autonomy and rights were enhanced. Participation in the programme appeared to undermine the participants’ dignity, particularly when individual needs were overlooked. An underlying reason could be the current move away from a comprehensive understanding of service users’ different needs and to a narrow focus on employability.     

Maternal influences on effortful control in adolescence: Developmental pathways to externalizing behaviors

Adolescents' effortful control is subject to numerous maternal influences. Specifically, a mother's own effortful control is associated with her child's effortful control. However, maternal substance use, psychopathology, and stress within the parenting role may also lead to poor effortful control for their child. Poor effortful control during adolescence can subsequently contribute to a variety of negative outcomes, including externalizing behaviors. A sample of 460 adolescents (47% female, 59.3% Non‐Hispanic Caucasian) was selected from a longitudinal, multigenerational study. The goal was to examine maternal effortful control, substance use, psychopathology, and stress in their offspring's childhood (M_age = 6.27) and their influence on their children's effortful control in early adolescence (M_age = 12.21) and the subsequent effect of effortful control on adolescents’ externalizing behavior (M_age = 13.53). Maternal effortful control (measured via conscientiousness) and psychopathology were associated with adolescent effortful control, which was associated with externalizing behavior a year later. Additionally, there was a significant indirect association between maternal effortful control and adolescent externalizing behaviors via adolescent effortful control. Thus, adolescent effortful control is associated with maternal effortful control but also subject to specific maternal risk factors in childhood. These results inform potential maternal strategies for promoting positive developmental outcomes in adolescents.     

Improving primary level home and community care services for older people: The case of Hong Kong

The aims of this study were to assess the impairment levels of users and waitlisted applicants for Hong Kong's Integrated Home Care Services (Ordinary Cases) (IHCS [OC]), reveal their possible hidden needs and potential demand for higher level services, assess their unmet needs for IHCS (OC) and explore whether not using IHCS (OC) was associated with any deterioration in impairment. In all, 567 respondents were clinically assessed twice, over a 6‐month interval, by the Minimal Data Set Home Care questionnaire. The results showed that some moderately or severely impaired respondents had only limited access to higher level services. Some respondents with either no impairment or only low‐level impairment had applied for higher level services. Most waitlisted applicants had not received any IHCS (OC), even after 6 months of waiting. Using IHCS (OC) or not had no significant impact on the deterioration in impairment. Several ways of improving home and community care services are discussed.     

Linking illicit substance misuse during pregnancy and child abuse: what is the quality of the evidence?

In most Australian states, legislation makes provision for professionals to report their concerns about the future welfare of an unborn child to appropriate authorities. The legislation establishes guidance for the implementation of family supports to minimize future child protection involvement. Given the legislation and the potential benefits, empirical research linking substance misuse during pregnancy and child protection involvement is relatively limited. We review 21 original studies linking substance misuse during pregnancy with child protection outcomes and the potential generalizability of results to the Australian context. The majority of studies reviewed were conducted in the USA and were mostly retrospective. Other differences between studies include sample sizes, comparison groups, study setting, participants’ ethnicity and pattern of drug use. In the postnatal literature, it is well established that child abuse is associated with a complex array of factors including partner, as well as broader family factors and yet, the studies reviewed focus upon maternal substance abuse without including the wider context. Given the available evidence‐based literature, it is difficult to come to definitive conclusions that can assist clinicians involved in frontline decision‐making for early intervention. Well‐designed research, accessible by antenatal health‐care professionals, is needed to adopt an evidence‐based approach to risk assessment in the prenatal context.     

Trust as a Means of Bridging the Management of Risk and the Meeting of Need: A Case Study in Mental Health Service Provision

Shifts in public policy towards an increasing focus on risk have been deemed problematic at a number of levels, particularly the tendency for concerns over reputational risk to institutions to trump the interests and needs of service‐users. This article explores the tension between these two dimensions, of risk and need, in a case study of local mental health services – a setting where conflicting objectives to manage risk and meet need are apparent. Media‐driven pressure to ward against the ‘risk’ represented by service‐users tends towards more coercive policy which may obstruct the meeting of need, which in turn may undermine service‐user engagement and hinder risk management. Drawing on qualitative data from interviews with service‐users, professionals and managers, the article explores the process of trust and its facilitative role in meeting need and managing risk. Findings suggest that while existing foci on risk are at times counter‐productive, trust plays a significant role in service‐users' initial and ongoing engagement, communication and co‐operation with professionals. Yet inherent obstacles to trust within mental healthcare contexts remain, due to cultural pressures on professionals, the nature of the illness experience and negative past experiences of in‐patient care.     

Social support available for substance‐dependent mothers from families with parental substance abuse

Substance‐dependent mothers, who have grown up with parental substance abuse, struggle during and after treatment to abstain from substances while trying to process traumatic experiences and integrate their family into society. The aim of this study was to explore the social support available for these mothers to help them stay abstinent and create safe family environments for themselves and their children. Using purposeful sampling, we approached nine mothers admitted for 1 year to a family ward at a substance abuse clinic and their significant others. Through in‐depth, qualitative interviews, first with the mothers, later with their significant others, we investigated characteristics of the available social support. The findings indicated that the significant others had limited resources and were themselves exposed to adverse and cumulative psychosocial and socioeconomic risk factors. Their relationships with the mothers were, nevertheless, close, consistent and reliable. Supporting the existing social network should be an integrated part of the work of family welfare services aiming to help substance‐dependent mothers from families with parental substance abuse to rehabilitate and to integrate successfully into local communities.     

Substance use and decision‐making in adolescent best friendship dyads: The role of popularity

In adolescent best friendship dyads, we examined: (a) similarity in substance use and decision‐making; (b) associations between participants' decision‐making and their own and best friend's substance use, (c) the influence of relative popularity within the dyad on these associations. Participants (n = 172; 12–18 years) named their best friend, completed popularity ratings, and a substance use questionnaire. Computer tasks were administered to assess risk‐taking and immediate reward preferences. Reciprocated same‐sex best friendship dyads (n = 49) were distinguished on their popularity, and we controlled for age differences between dyads in the analyses. Best friends were similar in substance use and risk‐taking preferences. More popular friends' risk‐taking preferences were positively associated with alcohol use of less popular friends. These findings underscore best friendship similarity in risky behaviors, and the influence of popular friends.     

Mothers and fathers in treatment for methamphetamine addiction—Parenting,parental stress,and children at risk

Parents addicted to methamphetamine (“crystal meth”) are likely to be impaired in meeting parental responsibilities, and the developmental settings can be highly disadvantageous for children. Therefore, parenting by methamphetamine‐addicted mothers and fathers needs further exploration, while considering the impact on children affected by parental substance use. In our study, we analysed parenting practices and parental stress as well as children's behavioural problems using standardized assessments. The sample consisted of 87 methamphetamine‐addicted parents in recovery. We obtained data on parents' current substance use and on their psychological distress. Multiple regression analysis was performed to identify predictors of children's overall problems. Parents reported high levels of parental and psychological distress, even after achieving abstinence. Especially depressive perceptions of parenthood appeared problematic. While recovering from methamphetamine addiction, parents exhibited a precarious psychosocial situation and problematic parenting behaviour. Dysfunctional parenting practices were evident in both indifferent and overreactive tendencies. Children were at risk of behavioural and emotional problems. Variables associated with parenting showed significant predictive value for children's overall problems, beyond current substance use, and psychological distress. These findings are discussed in terms of a family‐oriented perspective in order to promote parenting capabilities of methamphetamine‐addicted parents and to prevent problematic development of their children.     

Planned telephone support for disadvantaged parents in North Wales: perceptions of service users

This paper draws on the findings of a qualitative evaluation to examine user perceptions of a planned telephone support intervention based in a disadvantaged area in North Wales. Telephone support services are tailored differentially to offer information, advice and/or counselling on a crisis‐led or planned‐intervention basis. Research focusing on telephone support, for the most part (and particularly in the UK) has examined crisis‐led as opposed to planned support services. The findings of our study resonate with earlier research findings about telephone support that suggest provision of non‐visual support in social care can overcome some practical and financial difficulties for users with little discernible loss to their experience of satisfaction with the service. In addition, the paper suggests that planned support may provide a valuable service to users who are most disadvantaged and marginalized and who have found traditional forms of support unsatisfactory. For such users, planned telephone support can offer one‐to‐one communication tailored to specific client needs. Moreover, it can enable the development of user trust in the service which empowers users to operationalize strategies in the context of a reliable, sustained, unthreatening (and thus minimal risk) relationship.     

Postpartum depression and its correlates in middle‐class women in Hunan,China

Postpartum depression (PPD) has a negative impact on both infants and women. The middle‐class group is rapidly expanding with increased but unmet psychological needs. To determine the risk and its correlates of PPD in middle‐class women in Hunan, China. A sample of 306 middle‐class puerperae from obstetric wards of a large general hospital was enrolled in the study. Our results showed 55.6% middle‐class women were suspected PPD. Related risk factors included a history of complications, pregnancy stress, subjective support, and interaction effect between objective support and negative coping. The protective factors included objective support and an interaction effect between subjective support and negative coping. Early assessment and individualized guidance in terms of social support and coping to identify and prevent PPD in this population are required.     

The experiences of carers in using shared activities to communicate with looked‐after young people about alcohol,tobacco, and drug use

Parental conversations with their teenage children about alcohol, tobacco, and drugs are associated with lower rates of use. Looked‐after young people are at greater risk of early initiation, higher rates of use, and more problematic use. However, there is no evidence regarding whether these conversations occur in settings where the parental role is assumed by someone other than the biological parent. The aim of the study was to examine how carers communicate with looked‐after young people about alcohol, tobacco, and drug use. In‐depth interviews were conducted with 16 residential care staff and foster carers in Scotland. Data were analysed using a thematic analysis approach. Participants talked about “shared doing” as a way of building relationships and communicating about substance use. Shared doing encompassed particular activities that carers and young people would do together, such as driving in the car, cooking, watching TV, and going for a walk. Shared doing provided an opportunity to spend time together and to create an environment in which communication could be facilitated. These environments were shaped by space, time, and context. Carers should be encouraged to take advantage of the time‐limited occasions they are with young people to have conversations about substance use.     

Inter‐agency joint protocols for safeguarding children in social care and adult mental‐health agencies: a cross‐sectional survey of practitioner experiences

Parental mental illness, substance misuse and domestic violence are common risk factors for the maltreatment and neglect of children. Safeguarding children is everyone's responsibility, including professionals working primarily with adults. In the UK, Local Safeguarding Children Boards (LSCBs) were established to ensure that all agencies work together to safeguard children. Many LSCBs developed multi‐agency joint protocols to enhance collaboration, but there is limited evidence of their effectiveness. This paper reports findings from a cross‐sectional survey of practitioner self‐reported experiences of joint protocols, which was conducted in one inner London borough, to evaluate their impact on professional practice. A self‐complete questionnaire administered to all professionals in adult mental‐health and children's social care services in the borough yielded a response from 119 practitioners. The survey found that the protocols had been widely disseminated and provided clear guidance to practitioners. Practitioners perceived that they had increased awareness of the risk factors for safeguarding children and some had used the protocols to help them gain access to services for their clients. Practitioners also perceived that they had improved inter‐agency working between children's social care and adult mental‐health services. However, respondents indicated that positive interpersonal contact with practitioners from other agencies was equally important in promoting joint working and inter‐agency collaboration.     

Substance‐dependent women becoming mothers: breaking the cycle of adverse childhood experiences

Parenting may be particularly challenging for substance‐dependent mothers who have grown up with parents who themselves had substance use disorders (SUDs). The aim of this study was to explore how substance‐dependent mothers describe their childhood experiences with substance‐abusing parents and the association between these earlier experiences and their own role as caregivers. Using purposeful sampling, mothers admitted for 1 year to a family ward at a substance abuse clinic were approached. Through in‐depth, qualitative interviews, nine substance‐dependent mothers described their lives in the form of present, past and future tense. The findings indicate that substance‐dependent women, who have experienced SUDs in their families of origin, face several major challenges when they become mothers. Some describe having lived their whole lives ‘on the edge of society'. This makes their rehabilitation process more complex. All mothers work to abstain from substances, process traumatic experiences and integrate their family into society. They need help to build supportive social networks and to establish a safe and predictable family environment for themselves and their children. The therapeutic implications of these findings will be discussed.     

Going the Extra Mile? How Street‐level Bureaucrats Deal with the Integration of Immigrants

Dutch immigration and integration policies are being interpreted and implemented by local street‐level bureaucrats. We carried out 28 semi‐structured interviews with integration coaches, integration teachers and client managers in order to understand the dilemmas they face, and to explain their subsequent behaviour. The results show that although organizational characteristics such as the bureaucratic burden made street‐level bureaucrats reluctant to enlarge their discretionary space at the expense of policy rules, their willingness to help clients often transcends these boundaries under a combination of three conditions: high client motivation, extreme personal distress of the client, and negative assessment of existing policies and policy instruments (both in terms of fairness and practicality). Furthermore, street‐level bureaucrats were found to be constantly reinterpreting and revising their roles.     

Incorporating self‐determination into substance abuse prevention programming for youth transitioning from foster care to adulthood

Youth transitioning from foster care to adulthood are at higher risk for alcohol and substance abuse disorders than general population youth. At the same time, these youths are often recipients of strong clinical intervention, often at levels considered unnecessary, for other mental health or behavioural challenges. Because of this, there is sometimes resistance from providers to offer services such as substance abuse prevention programming as it may be seen as contributing to youths' overclinicalization, stigmatization, or retraumatization. Using thematic content analysis, this qualitative study analysed focus groups with community stakeholders providing recommendations on support services for youth transitioning from foster care to adulthood to derive strategies for delivering substance abuse prevention programming in a way that enhances youth self‐determination. Findings were organized by self‐determination theory's 3 key psychological needs: autonomy, competence, and relatedness. All three needs were represented in stakeholder recommendations, which were translated into strategies for bolstering youths' achievement of each need. Strategies include a mix of those already present in motivational interviewing‐based brief substance abuse prevention interventions as well as more unique strategies that are much less frequently employed but that may better meet the needs of youth with foster care experience.