Minority Stress,Emotion Regulation,and the Parenting of Sexual-Minority Youth

ABSTRACT

Despite increasing societal acceptance of sexual-minority individuals, there are still gay, lesbian, and bisexual (GLB) adolescents who experience negative mental health outcomes. Minority stress theory posits that stigma-related stress associated with sexual-minority status drives increased risk among GLB individuals. Furthermore, recent evidence suggests that minority stress impacts emotion regulation (ER), identified as a particularly important risk factor for sexual-minority youth (SMY). Current research has identified some aspects of parenting contribute to GLB youth's mental health. We review the literature in these areas, and also integrate research from the broader developmental field on families and emotion socialization in order to identify the need for studies of parenting that go beyond existing data on parental acceptance and supportiveness of youth's sexual orientation. Limitations of the current literature and directions for future research are discussed, with specific focus on implications for interventions with SMY and their families.     

The impact of mental health issues, substance use, and exposure to victimization on pregnancy rates among a sample of youth with past-year foster care placement

The purpose of this study is to (1) compare youth entering substance abuse treatment with and without a history of foster care placement to determine any differences in mental health, substance use, and exposure to victimization, and (2) determine if mental health, substance use, and/or exposure to victimization predict past pregnancy among the sample with a history of foster care placement. The pooled dataset consisted of 17,124 adolescents (12-17 years of age) who completed the Global Appraisal of Individual Needs at intake for substance abuse treatment in 2009. Of these, 366 (2.1%) reported having been in foster care in the past year. When compared with a non-foster care sample, the foster care sample reported significantly higher internal mental distress scores, behavior complexity scores, and general victimization scores, after controlling for race, gender, and level of care. Problems associated with substance use did not differ between groups, though regular tobacco use was present at a higher rate in the foster care sample. Multivariate logistic regression results revealed that, within the foster care sample, internal mental distress and gender predicted past pregnancy. There may be room for intervention within substance abuse treatment centers for youth with a history of foster care, who may be at risk for pregnancy if their levels of internal mental distress are high.     

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.     

Coming out of the dark: content analysis of articles pertaining to gay, lesbian, and bisexual issues in couple and family therapy journals

The present study seeks to extend previous research regarding literature related to gay, lesbian, and bisexual (GLB) issues published in couple and family therapy (CFT)-related journals by presenting the results from a content analysis of GLB studies in CFT-related journals from 1996 to 2010. Results of the analysis revealed a 238.8% increase in total GLB content published since the original review. Articles pertaining to therapy with GLB clients continue to represent the largest area of publication. With one exception, all surveyed journals showed an increase in the percentage of GLB content since the first study. Emerging areas of research include studies related to supervision and training, GLB mental health and substance use, and sexual minority adolescents. A movement away from deficit-based perspectives could open a new lens on family life.     

Perceived self-stigma in the utilization of mental health services in foster care and post foster care among foster care alumni

Foster youth experience higher rates of mental health disorders and receive higher rates of mental health services in comparison to the general population. Yet, upon foster care exit, mental health service use drastically declines. Little is known as to the reasons for mental health service decline after foster care exit. However, research studies in the mental health literature have consistently shown that self-stigma and public stigma are significant in mental health service receipt. Studies have also shown that self-stigma affects an adolescent's self-identity, self-efficacy, and interpersonal relationships, which impact self-sufficiency once youth leave foster care. This study explores self-stigma in the utilization of mental health services while in foster care, and whether the stigma developed while in foster care impacts mental health service use upon foster care exit. The role of public stigma in the utilization of mental health services post foster care is also examined. Thirteen former foster youth with a mental health treatment history while in foster care were interviewed. Results show that foster youth experienced self-stigma, which increased the negative impact of mental health service receipt while in foster care. After foster care exit, youth who identified experiencing self-stigma while in foster care tended to discontinue mental health services after foster care exit. In contrast, foster youth who did not identify self-stigma in the receipt of mental health services while in foster care continued accessing services upon foster care exit. Public stigma was not identified as influencing mental health service use post foster care, but was coupled with negative labels, stereotypes, and negative perceptions. Implications for preventive and intervention measures are also discussed/proposed.     

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.     

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.     

Patterns of Adolescent Regulatory Responses During Family Conflict and Mental Health Trajectories

Four distinct patterns of adolescents' behavioral, emotional, and physiological responses to family conflict were identified during mother–father–adolescent (M = 13.08 years) interactions. Most youth displayed adaptively regulated patterns comprised of low overt and subjective distress. Under‐controlled adolescents exhibited elevated observable and subjective anger. Over‐controlled adolescents were withdrawn and reported heightened subjective distress. Physiologically reactive adolescents had elevated cortisol coupled with low overt and subjective distress. Regulation patterns were associated with unique mental health trajectories. Under‐controlled adolescents had elevated conduct and peer problems whereas over‐controlled adolescents had higher anxiety and depressive symptoms. Physiologically reactive adolescents had low concurrent, but increasing levels of depressive, anxiety, and peer problem symptoms. Findings underscore the importance of examining organizations of regulatory strategies in contributing to adolescent mental health.     

Adolescents’ Subjective Social Status Predicts Day‐to‐Day Mental Health and Future Substance Use

Adolescents’ subjective social status (SSS) is associated with mental and behavioral health outcomes, independent of socioeconomic status (SES). Many previous findings, however, come from cross‐sectional studies. We report results from a longitudinal study with 151 adolescents identified as at risk for early substance use and behavioral problems sampled from low‐SES neighborhoods. We examined whether adolescent's SSS predicted mental health (depression, anxiety, and inattention/impulsivity) measured over 30 days via ecological momentary assessment and risk for substance use at an 18‐month follow‐up. Results showed that with each perceived step “up” the SSS ladder, adolescents experienced fewer mental health symptoms in daily life and lower future substance use risk after adjusting for objective SES and previous psychopathology. Implications of these findings are discussed.     

Internalizing symptoms and safe sex intentions among adolescents in mental health treatment: Personal factors as mediators

Little is known about why some adolescents with internalizing symptoms engage in sexual behaviors that increase their risk for HIV. This study tested a mediation model of internalizing symptoms and safe sex intentions among adolescents receiving mental health treatment. Self-efficacy for HIV prevention, HIV knowledge, and worry about HIV were hypothesized to mediate associations between internalizing symptoms and safe sex intentions among sexually active and non-active adolescents receiving mental health treatment (N = 893, M age = 14.9). Significant indirect effects from internalizing symptoms to safe sex intentions varied according to sexual experience: for sexually non-active adolescents, HIV worry and knowledge mediated this link, whereas for sexually active adolescents, HIV self-efficacy was the significant mediator. Increasing both HIV knowledge and self-efficacy for HIV prevention are important targets for HIV prevention with adolescents with internalizing symptoms, and careful attention should be paid towards targeting these interventions to sexually experienced and inexperienced youth.     

Stress and Adaptation Among Families of Lesbian,Gay, and Bisexual Youth

Abstract

As research has accumulated on gay, lesbian, and bisexual (GLB) youth, more attention is being directed to their families. Research on the families of GLB youth is limited, although several studies have identified parental reactions to learning their offspring is GLB, and others have attempted to discover patterns of responses within families. Some problems with current research on the families of GLB youth are identified. A human development model is described which can help direct future research efforts.     

Organized Religious Involvement and Mental Health Among Caribbean Black Adolescents

Though religion has been related to better mental health, the aspects of organized religious life most salient for the mental health of Caribbean Black adolescents in the US, beyond religious service attendance, has been understudied. This research utilized a sub-sample of Caribbean Black adolescents from the NSAL-A, a nationally representative U.S. dataset, to examine (1) the prevalence of organized religious involvement (e.g., participation in religious service activities, choice to attend religious services) and (2) the relationship between organized religious involvement and mental health. Results showed that 62 % of Caribbean Black adolescents attend religious services regularly (at least a few times a month) and 49 % or more attend religious services or participate in religious activities (e.g., youth groups) by choice. Additionally, various aspects of organized religious involvement were positively related to coping and self-esteem, and negatively related to depressive symptoms. Religious service attendance was not related to any of the mental health indicators. Study results can inform the development of individual and group level interventions targeted at supporting the mental health of Caribbean Black adolescents.     

Three Psychotherapies for Suicidal Adolescents: Overview of Conceptual Frameworks and Intervention Techniques

Suicide is the second leading cause of death among youth, and as many as one in five youth report having had at least one serious thought of suicide in the past year. Despite the enormous emotional pain and suffering associated with suicidal thoughts and behaviors, up to 40 % of suicidal youth never receive treatment. Given that social workers are employed in multiple settings where suicidal children and adolescents are encountered (e.g. schools, homeless shelters, emergency departments, outpatient mental health agencies, private practice), they play a critical role in the identification and treatment of suicidal youth. In the past decade, evidence has emerged that attachment-based family therapy, integrated cognitive behavioral therapy, and dialectical behavior therapy can reduce suicidal ideation and/or suicide attempt in youth. The purpose of this article is to review the theoretical assumptions, conceptual frameworks and key intervention techniques for these three interventions so that clinicians can integrate these approaches into their practice with suicidal youth and families. Implications for practice are integrated throughout the review.     

Patterns and priorities of service need identified through the Child and Adolescent Needs and Strengths (CANS) assessment

Using recursive partitioning on thousands of enrollment Child and Adolescent Needs and Strengths (CANS) assessments, we identified characteristics of the most troubled children/youth requiring comprehensive interventions reflected by a count of total actionable items (TAI) from 129 possible CANS actionable treatment planning items. Samples included 2557 and 6982 children/youth from two separate large, multi-program, California-based mental health treatment agencies administering CANS routinely upon enrollment. In two separate random forest analyses, 20 top predictors were identified which indicated very high levels of clinical severity needing comprehensive, urgent intervention at each agency, with 13 out of the 20 predictors common to both agencies' populations. Agency-specific decision trees were constructed with the top 20 predictors to examine relationships between predictors, which further identified four predictors of need highly prioritized at both agencies: child's frustration management problems, recreation and leisure time activity challenges, poor response to consequences for aggressive behavior, and lack of optimism. Within these service populations, children with actionable need for intervention in these four areas had four to five times more TAI as compared to children without these areas identified. A handful of the CANS items assessed can indicate very high severity ratings for a service population, and localized use of recursive partitioning analysis based on TAI can identify these core problems for specific programs or across agencies, helping clinicians to understand patterns and priorities within populations served.     

Implementing Cognitive Behavioral Intervention for Trauma in Schools (CBITS) with Latino Youth

Objective

Many Latino youth are often unable to access mental health services and support following exposure to traumatic and stressful events. This study assesses the benefits and effectiveness of utilizing Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a school based intervention, with Spanish speaking, Latino youth residing in New Orleans, Louisiana, in effort to address presenting symptoms of trauma and depression.

Method

Twenty three children and adolescents ages 10 to 14, in fifth, sixth and seventh grades, presenting with symptoms of trauma and depression, participated in a 10 week program of CBITS which was primarily conducted in Spanish.

Results

Children who participated in CBITS reported significantly fewer symptoms of trauma and depression following the intervention; however, no differences were noted between genders. Significant differences were observed between older boys and girls (12–14), as they were more likely to report higher levels of exposure to trauma than younger boys and girls (10–11). The effect sizes for the intervention were large.

Conclusions

Findings of this study suggest that CBITS is a practical and effective school based intervention available to mental health providers as a resource to be used with Spanish speaking, Latino youth who have been exposed to different forms of stress and trauma.

     

Associations Between School Connection and Depressive Symptoms From Adolescence Through Early Adulthood: Moderation by Early Adversity

Depressive symptomatology is one of the most common and costly threats to American mental health, making the elucidation of environmental influences on depressive symptoms particularly important. Using the National Longitudinal Study of Adolescent Health, this study explores the interaction between environmental risk and protective factors in the etiology of depressive symptoms by asking whether school connection is associated with lower levels of depressive symptoms through early adulthood, and whether connection serves as a protective or promotive factor for youth who experienced early adversity. Findings highlight the importance of school connection in promoting long‐term mental health for all youth and suggest that policies and practice supporting school connection may be effective intervention strategies for youth at risk for depressive symptomatology.     

Adolescents in residential treatment: The prevalence of ACEs,substance use and justice involvement

Abstract

Although associations between developmental trauma, juvenile justice involvement and youth substance use have been previously reported in the published literature, the interconnection among these three factors has not been adequately studied. This article describes the interconnection among these three factors and calls for greater attention to the role of adverse childhood experiences (ACEs) in the diagnosis and treatment of youth who present with histories of substance use and/or offending behavior. Pilot data are presented that show high rates of self-reported trauma exposure, substance use history, justice involvement, and mental health problems in a sample of adolescents in residential treatment. The data point to the need for residential treatment centers to consider trauma histories in developing treatment plans for youth with current and prior substance use and offending behavior.     

What does self-esteem have to do with behavioral health among low-income youth in Chicago?

Many studies have examined risk factors associated with poorer behavioral health among low-income African American youth, such as low school engagement, delinquency, mental health problems, drug use, and risky sex. However, fewer studies have examined protective factors for such behavioral health risk behaviors. This study sought to address this gap by examining whether high levels of self-esteem were associated with better behavioral health factors for this population. A survey was administered to a sample of 638 low-income African American adolescents in Chicago to examine the degree to which high self-esteem was associated with less delinquency, substance use, and sexual risk behaviors, and more school engagement, and whether such associations varied by gender. Stepwise linear and logistic regression models were estimated to assess the influence of self-esteem. Higher self-esteem for this sample of low-income African American adolescents was associated with lower rates of delinquency, drug use, and risky sexual behaviors and increased rates of school engagement. Gender moderated only a few of these relationships. These findings suggest that programs that promote high self–esteem alone or in combination with other resilience factors may promote better behavioral health factors for African American adolescents.     

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.     

Effectiveness of brief intervention and case management for children and adolescents with mental health difficulties

ObjectiveTo compare the effectiveness of a Brief Intervention (BI) and Treatment As Usual (TAU) in a sample of children and adolescents seeking mental health treatment from a Child and Youth Mental Health Service (CYMHS). BI comprised up to six sessions of psychological therapy from trainee psychologists, and TAU involves case management incorporating assessment and psychological treatment (e.g., individual, parent, family therapy), plus linkage to other services.MethodA matched subjects design was used to evaluate the BI (n = 79) and TAU (n = 79) treatment conditions. Participants were matched according to age, gender, and baseline symptom scores on the Health of the Nations Outcome Scale for Children and Adolescents (HoNOSCA), which was completed at pre- and post-treatment. The HoNOSCA is a clinician-rated measure of symptoms experienced in the previous two weeks.ResultsBI and TAU both significantly reduced mental health symptoms, with no significant difference between treatments overall, on Externalising or Emotional problems subscales, or on the percentage of most problematic items for participants.ConclusionsBI was as effective as TAU in reducing mental health symptoms in some children and adolescents. BI however is briefer, and could form part of a Stepped Care model for CYMHS. Further research is required to establish the most effective elements of BI in reducing mental health symptoms.