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.     

Comparison of basic data for the National Survey of Residential Group Care Facilities: 1966-1982

Major findings from this analysis of the data gathered in preparation for the 1966 and 1981 surveys of children's residential group care facilities are as follows below. In the field of residential care of pregnant adolescents, it appears that, despite an increase in the number of births to adolescent mothers since 1966, the preferred mode of serving this population is no longer residential group care. While there has been a small increase (6 facilities) in the number of residential facilities for pregnant adolescents that operate under public auspices, the 49% decrease in facilities under private auspices is the real indicator of the direction of residential services to pregnant adolescents since 1965. In the Child Welfare Stream, the most notable change between 1965 and 1981 was the decrease in the relative proportion of residential group care facilities for dependent, neglected, or abused children and youth. Overall, child welfare facilities accounted for 55% of all residential facilities listed for survey in 1965; in 1981 this percentage had fallen to 37%. As in 1965 the Child Welfare Stream was dominated by the private sector in 1981, with 83% of all child welfare facilities operating under private auspices. This pattern was found for most of the 50 individual states as well. In the Juvenile Justice Stream, the overall increase of 154% in the number of residential facilities since the 1965 listing is due in part to a notable increase in the number of private facilities in this stream of care. Although the majority of juvenile justice facilities are still public, there has been an increase of 17% since 1965 in the proportion of facilities under private auspices. An even greater increase in total number of facilities than was seen in the Juvenile Justice Stream is seen in the mental health field between 1965 and 1981. There were almost four times as many residential mental health facilities listed for survey in 1981 as in 1965. From representing about one-eighth of the total number of all residential group care facilities for children and youth with special problems or needs, the Mental Health Stream increased to a quarter of all such facilities by 1981. As in the earlier study, the Mental Health Stream was dominated by the private sector in 1981. The proportion of mental health facilities under private auspices had increased by 16% since 1965, indicating an even greater involvement of the private sector in the delivery of residential mental health services to children and youth.(ABSTRACT TRUNCATED AT 400 WORDS)     

Foster parent perspectives of privatization policy and the privatized system

This study focused on foster parent perspectives of foster care privatization in the state of Florida. Ninety-nine members of Florida's foster parent associations were surveyed with a special attention toward their stance on privatization policy and their views of the local private agencies that deliver services in the privatized system. Results identified no clear consensus on the topic of privatization policy. Policy support was more likely to be seen among foster parents who had not served prior to privatization and among foster parents who viewed the local private agency to be competent and responsive. Views of local private agencies were most strongly influenced by the foster parents' satisfaction with foster parent training, their involvement in case decision-making, and the kindness of the foster care worker. These results have implications for practice in the privatized foster care system and for research in the evaluation of these systems.     

Peer contagion among youth in Medicaid-funded residential mental health treatment programs

This paper examined juvenile justice encounters among youth with mental health needs who received care in residential treatment settings. The focus is on peer effects, and whether delinquent peers negatively affected youth. Matched data from Florida Medicaid and Juvenile Justice were used to examine the association between peer delinquency in a residential treatment setting and juvenile justice encounters during and after the treatment episode. Fifteen percent of youth had justice encounters during residential out-of-home treatment, while the rate was lower in the six months after (23.0%) treatment than the six months before (33%). Support for peer contagion was found as youth treated in Medicaid-funded residential mental health treatment programs were more likely to have JJ encounters when the other youth in the facility had histories of delinquency.     

Risk and selection processes between the general and the specialty mental health sectors

This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder.     

Childhood trauma and risk for suicidal distress in justice-involved children

Justice-involved children (JIC) have higher rates of trauma exposure and suicidality than the general population. The Childhood Trauma Model predicts that children can accumulate multiple traumatic experiences that can be more harmful than a single traumatic event. The purpose of this study is to investigate the individual and cumulative effects of childhood trauma on suicidal distress among JIC. The study employs logistic regression to analyze panel data on 2367 12–16 year-olds from the Florida Department of Juvenile Justice (FLDJJ). The study shows that 9 types of individual traumatic experiences increased risk for suicidal ideation from 22 to 180%. For one unit increase in the trauma score, the risk for suicidal distress increased 25%, so that JIC who experienced 5 types of traumas were 2.4 times more likely to experience suicidal distress as JIC who experienced a single trauma. These findings illustrate the need to invest mental health services and suicide prevention resources in populations in the juvenile justice system. Intervention must be tailored to serve children who suffered specific traumatic events, as well as those who experience multiple types of trauma. Further, policies that manage JIC as kid criminals rather than as traumatized children may exacerbate their suicidality and problematic behavior.     

Managed Mental Health Care for Employees:

Managed mental health care has become an increasingly significant influence in the timely, appropriate and cost-conscious delivery of mental health and substance abuse services. Social workers are being presented with new career paths in the private sector as EAP programs and managed health care corporations Look to them to provide the case review, supervision, provider selection, and the quality assurance functions of a well integrated managed health care system.     

Race,Substance Abuse,and Mental Health Disorders as Predictors of Juvenile Court Outcomes: Do They Vary By Gender?

Predicting juvenile court outcomes based on youthful offenders’ delinquency risk factors is important for the adolescent social work field as well as the juvenile justice system. Using a random sample of 341 delinquent youth from one Midwestern urban county, this study extends previous research by examining if race, substance abuse, and mental health disorders influence important delinquency outcomes (number of court offenses, felony conviction(s), probation supervision length, detention length, and number of probation services) differently for male and female juvenile offenders. Multivariate analysis findings revealed that race was significant only for males, and having a substance use disorder was a stronger predictor of delinquency outcomes for males; whereas, having a mental health disorder was a stronger predictor of delinquency outcomes for females. Implications for this research include the importance of early disorder identification and subsequent availability of gender-focused treatment.     

Peer Support Among Consumers of Professional Mental Health Services

ABSTRACT

Peer-support services have become increasingly prevalent in mental health; consumers now deliver many services once provided by professional mental health providers. Recognizing this key asset in mental health consumers' service environment is critical for social workers. This exploratory study examines differences among 311 consumers of professional mental health services, half of whom also used peer-support services. The two groups (peer support compared with non-peer-support) were compared on a number of dimensions related to their utilization of and satisfaction with professional mental health services. Users of peer-support services perceived greater availability of professional services and used more professional services, but found professional services to be less useful than those not participating in peer support. No differences between the two groups were found for overall satisfaction with professional services. Findings related to policy, practice, and research are discussed.     

Factors Associated with Drug Treatment Entry Patterns Among Hispanic Women Injection Drug Users Seeking Treatment

SUMMARY

This paper examines patterns of drug treatment entry and factors that are associated with these patterns among 1,849 Hispanic women injection drug users (IDUs). The data analyzed originates from a statewide drug-treatment database covering seven years, 1996–2002. Through the use of logistic regression analyses, the study identified significant differences in predisposing, need and enabling factors in the use of detoxification only, residential treatment, or methadone maintenance. Compared to other Hispanics, Puerto Rican women were 40 percent less likely to use only detoxification services and one and a half times more likely to use methadone maintenance. Having health insurance was an especially important factor associated with methadone treatment utilization. Two of the most important factors associated with residential treatment use were history of mental health services utilization and involvement with the criminal justice system. This article discusses specific social work practice implications including the need for social work practitioners to promote services such as residential treatment, to be trained in treatment of co-occurring mental health disorders, especially among women in residential treatment, and the need to establish close linkages with the mental health and criminal justice systems.     

Suicide among elderly white men: development of a profile.

1. Older white men have the highest suicide rate in the nation; a linear increase of suicide occurs with each passing year of chronological age. 2. Elderly who attempt suicide are more likely to communicate their intentions less frequently and to use violent and lethal means. 3. Chronic sleep problems, pain, degenerative illness, or clinical depression may be experienced by older white men at suicidal risk; somatic complaints including imaginary symptoms can mask depression. 4. Educational programs, outreach mental health programs, and enhanced consultation/coordination improve case findings and early intervention. Holistic nursing care, including pain alleviation, depression assessment, and simple comfort measures, are imperative in suicide prevention in the elderly.     

Health maintenance behaviors of individuals with severe and persistent mental illness in a state prison

The purpose of this grounded theory study is to define health and health-seeking behaviors of incarcerated individuals experiencing severe and persistent mental illness (SPMI) in a state prison. The strategies used to prevent loss of control and maintain health in the prison environment were examined. Nineteen incarcerated individuals with SPMI were interviewed in a state prison. Constant comparative analysis of the data revealed that while establishing a "fit" with the core variable "loss of control" and its identified properties, differences were found in the enactment of health maintenance behaviors related to properties in the prison environment. Several of these behaviors are inconsistent with behaviors expected of individuals in a community day treatment center and reflect a need for bridging programs to facilitate entry into the "free" world. Correctional nurses and mental health providers in this system can advocate for incarcerated individuals with SPMI by developing programs that provide cost-effective intermediate care and collaborating with community health systems for continuity of care. The findings related to alcohol and drug abuse among incarcerated individuals with SPMI challenges mental health providers in both correctional facilities and community-based programs to generate appropriate and effective substance abuse treatment programs for these individuals.     

Contracting out of basic health facilities in Pakistan: Are the lessons generalizable?

Amid growing support within international development agencies for the privatization of health facilities in developing countries, contracting out of the Basic Health Units (BHUs) in Pakistan has been presented as a success. This article argues for caution in generalizing results from this model. It shows that the model improved service delivery because the organization taking over the BHUs was itself a government‐owned QUANGO (Quasi‐Autonomous NGO); similar concessions would not have been granted to a private provider. Further, the article shows that, given the strong resistance that the model continues to receive from administrators within the state system, development agencies must consider whether models that try to sidestep the bureaucracy instead of working towards installing good practice within the state system, can be viewed as a success.     

Clinical Social Work Practice with Former System Youth with Mental Health Needs: Perspective of Those in Need

The purpose of this study is to describe the types of programs and mental health services former system youth with mental health histories would be inclined to engage in to manage their mental health difficulties, along with the factors that might hinder them from engaging in these services. A series of closed and open-ended questions on potential programs and services were asked, as part of a larger study. Participants were former system youth; specifically 18?C30?year olds who were diagnosed with a mood disorder and were involved with public mental health and social services (e.g., public welfare, child welfare, juvenile justice) during childhood. Responses to the open-ended questions were categorized and percentages are reported from the yes/no items. Eighty-three percent and 76% reported that they would be enticed to come to a support group and panel discussion on mood disorders, respectively, while only 46% reported that they would attend a family support group. Talking with others who have had similar experiences, material possessions and creative expression were the most common responses regarding what would entice them to get involved. Further, peer disrespect, transportation, and daycare were common barriers to potential participation. As the field continues to build knowledge on system-wide strategies to improve agency-based mental health care for transitioning youth and young adults, new evidence-based approaches may benefit from listening to the specific needs, preferences, and suggestions of these youth themselves.     

HMOs and the Future of Student Mental Health Services

Abstract

The health maintenance organization (HMO) is likely to have a prominent position under national health insurance, which will have a strong systematizing effect on the nation's health services. Over the past two years the University of Massachusetts mental health services have provided benefits at both the university and a private medical group practice. Experience has shown that a university which already provides broad services to a large student population can extend itself to the university community including its faculty and staff. Several advantages of this development, as well as some significant problems, are discussed. As the HMO grew and quality services were established, it became feasible for the private medical group to develop its own mental health component. Based on this and other experiences in mental health delivery systems, certain conclusions are drawn about the ways universities can develop HMOs and some recommendations are made for national mental health planning.     

Impact of client suicide on social workers and counselors

Recent studies on the impact of client suicide on mental health professionals focus on psychiatrists and psychologists, while,in the current mental health system in our country, most clients receive services from other clinicians. This research focuses on the impact of client suicide on social workers and counselors as well as organizational responses to client suicide/attempt. Data were collected via interviews and survey of 121 clinicians. Client suicide impacts clinicians adversely in many ways. Many participants felt their agency/practice could have done more to support them during post-suicide management. Data presented in this report have the potential to aid in the creation of needed workforce development initiatives.     

Mental illness and help-seeking behavior among Mariel Cuban and Haitian refugees in south Florida.

Differences in psychopathology and use of the mental health system by recent refugee groups are explored in light of competing hypotheses stemming from theories of immigrant adaptation and minority mental health. Results show that would-be Haitian refugees arriving in South Florida during the early 1980s had relatively small needs for mental health care, but whatever needs they had were largely unattended by the health services system. Mariel Cubans had far greater needs that were mostly met satisfactorily by virtue of their familiarity with service facilities prior to departure and their incorporation into a favorable social environment. These contextual factors are added and compared with the individual-level predictor variables suggested by Andersen and others. The results' implications for theories of immigrant mental health and help-seeking and for the implementation of effective delivery programs are discussed.     

Mental health service utilization in children adopted from US foster care,US private agencies and foreign countries: Data from the 2007 National Survey of Adoption Parents (NSAP)

Aims

In this analysis, we (1) described the rate of mental health service utilization for children from domestic foster care adoption, domestic private adoption, and international adoption and (2) analyzed the effect of common risk factors on mental health service utilization.

Data

As part of the 2007 National Survey on Adoptive Parents (NSAP), parents with children 5–17 years old (N = 1722) were asked if their children had received mental health services and how helpful these services were. Parents also provided data on the children's demographics and likelihood of pre-adoption adversity (e.g., abuse).

Results

For boys, mental health services were utilized by 52.4% of domestic foster care adoptees, 41.0% domestic private adoptees, and 40.0% of international adoptees. For girls, the corresponding rates were 36.3%, 24.8%, and 30.9% respectively. Parents reported that the services were very helpful for about half of the children. Logistic regression analyses showed that adoptees from domestic foster care were more likely than international adoptees to have received mental health services, but there was no difference between domestic private adoptees and international adoptees. Older age at placement, older age at assessment, having special health care needs, and being male all increased the odds for having received mental health services.     

Collaboration Between Community Mental Health and Juvenile Justice Systems: Barriers and Facilitators

Recent studies have confirmed a high prevalence of youth with diagnosable mental health disorders within the juvenile justice system, as well as the vulnerability of youth in the mental health system who enter the juvenile justice system. This high prevalence of dual system involvement has spawned challenges of collaboration between the mental health and juvenile justice systems to provide needed services to youth and their families. Seventy-two in-depth interviews were conducted with 18 youth and their parents/guardians, mental health professionals from five different community mental health centers, and juvenile justice professionals in urban and rural communities in a Midwest state in the United States. Professionals, youth and parents identified several important factors that facilitated collaboration, as well as a myriad of barriers that needed to be overcome. Findings suggest ways to improve partnerships between the two systems and the development of supportive policies and procedures.