Utilization of alcohol, drug, and mental health treatment services among American Indian adolescent detainees

Reservation-Urban Comparison of Suicidal Ideation/Planning and Attempts in American Indian Youth

BACKGROUND

Our aim was to identify sex- and location-specific risk factors for suicide ideation/planning and attempts among American Indian youth.

METHODS

Biennial data for 6417 American Indian high school students attending reservation and urban schools were extracted from the Montana volunteer sample Youth Risk Behavior Survey data for pooled years 2003 to 2011. Logistic regression was used to identify sex- and school location-specific risk behaviors and psychosocial factors for past 12-month ideation/planning and past 12-month attempts.

RESULTS

Contrary to our hypothesis, the prevalence of ideation/planning and attempts did not significantly differ between reservation/urban location; however, risk factors associated with suicidality did. Sadness/hopelessness was associated with both outcomes for all groups. However, violent victimization was associated with both outcomes only among girls. Lack of school safety was associated with attempts but not ideation/planning among all students. There were distinct differences in risk factors associated with both outcomes among boys.

CONCLUSIONS

The results indicate differences and similarities in risk behaviors and psychosocial factors associated with suicidality by sex and reservation/urban setting. Implications include screening potentially at-risk students for depression, violent victimization, substance use, and school safety and use of the findings by tribal and school programs in designing prevention and intervention programs.

Organizational Context and Individual Adaptability in Promoting Perceived Importance and Use of Best Practices for Substance Use

This study examines associations among organizational context, staff attributes, perceived importance, and use of best practices among staff in community-based, juvenile justice (JJ) agencies. As part of the National Institute on Drug Abuse's Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, 492 staff from 36 JJ agencies were surveyed about the perceived importance and use of best practices within their organization in five substance use practice domains: screening, assessment, standard referral, active referral, and treatment support. Structural equation models indicated that supervisory encouragement and organizational innovation/flexibility were associated with greater individual adaptability. Adaptability (willingness to try new ideas, use new procedures, adjust quickly to change), was positively correlated with importance ratings. Importance ratings were positively associated with reported use of best practices. Organizational climates that support innovation likely affect use of practices through staff attributes and perceptions of the importance of such services.

Falling between two systems of care: Engaging families, behavioral health and the justice systems to increase uptake of substance use treatment in youth on probation

Justice-involved youth (JIY) in the US have high rates of substance use (SU) problems, yet 50%-80% of these youth do not receive necessary services. There has been no systematic exploration of the use of treatment services for JIY that examines viewpoints across stakeholders in justice- and treatment-systems as well as the families. We conducted qualitative interviews and focus groups with n = 58, youth, their caregivers, SU treatment providers and probation officers in a Northeastern state. Interviews explored how families, staff- and system-level factors influence uptake of and retention in SU treatment services in youth on probation. We conducted a thematic analysis of all interview texts. Caregiver engagement is essential for youth treatment uptake and retention. Difficulties achieving caregiver engagement and agreement that treatment was necessary stemmed from distrust in the "system"; denial or minimization of youth's SU problem; relational barriers; and overburden and chaos within the family system. Structural barriers to service uptake were lack of available treatment options, SU agency practices and policies, and interagency collaboration between SU treatment agencies and probation. Enhancing family engagement at the point of referral to SU treatment is essential. Improvements in interagency collaboration and communication between SU treatment and probation agencies are necessary. Implications for policy and intervention are discussed.

Behavioral Health Service Utilization Among Detained Adolescents: A Meta-Analysis of Prevalence and Potential Moderators

PURPOSE

Utilization of behavioral health treatment services among adolescents who have been detained or incarcerated within the juvenile justice system is poorly understood, with estimated utilization rates varying widely across studies. This meta-analysis was conducted to review and synthesize the literature on the prevalence of service utilization among this population.

METHODS

Data from 27 studies of 28 distinct samples were abstracted and coded. A meta-analysis was conducted to calculate individual prevalence estimates of behavioral health service utilization, which were combined using random effects models. A moderator analysis was also conducted.

RESULTS

Prevalence effect sizes (pr) for service utilization were low, with effect sizes pr = 33.1% for mental health services, pr = 27.95% for substance use-related services, and pr = 45.32% for unspecified services. The moderator analysis showed significant heterogeneity in prevalence of behavioral health service utilization.

CONCLUSIONS

The findings suggest limited service utilization by adolescents who had been detained or incarcerated, whether assessed before, during, or after confinement. Future research should focus on assessing the quality of, and youth access to, behavioral health services within and outside of juvenile justice facilities. Improved programs to ensure consistent treatment for previously detained or incarcerated adolescents are warranted.

Behavioral Health Care Needs, Detention-Based Care, and Criminal Recidivism at Community Reentry From Juvenile Detention: A Multisite Survival Curve Analysis

OBJECTIVES

We examined the provision of behavioral health services to youths detained in Indiana between 2008 and 2012 and the impact of services on recidivism.

METHOD

We obtained information about behavioral health needs, behavioral health treatment received, and recidivism within 12 months after release for 8363 adolescents (aged 12-18 years; 79.4% male). We conducted survival analyses to determine whether behavioral health services significantly affected time to recidivating.

RESULTS

Approximately 19.1% of youths had positive mental health screens, and 25.3% of all youths recidivated within 12 months after release. Of youths with positive screens, 29.2% saw a mental health clinician, 16.1% received behavioral health services during detention, and 30.0% received referrals for postdetention services. Survival analyses showed that being male, Black, and younger, and having higher scores on the substance use or irritability subscales of the screen predicted shorter time to recidivism. Receiving a behavior precaution, behavioral health services in detention, or an assessment in the community also predicted shorter time to recidivating.

CONCLUSIONS

Findings support previous research showing that behavioral health problems are related to recidivism and that Black males are disproportionately rearrested after detention.

Pathways to care: narratives of American Indian adolescents entering substance abuse treatment

Using data from 89 American Indian adolescents and guided by the Network Episode Model, this paper analyses pathways to residential substance abuse treatment and their correlates. These adolescents were recruited at admission to a tribally-operated substance abuse treatment program in the southern United States from October 1998 to May 2001. Results from the qualitative analyses of these adolescent's pathways to care narratives indicated that 35% ultimately agreed with the decision for their entry into treatment; 41% were Compelled to enter treatment by others, usually by their parents, parole officers, and judges; and 24% did not describe a clear pathway to care. In the multinomial logistic regression model examining correlates of these pathways to care classifications, adolescents who described pathways indicative of agreement also reported greater readiness for treatment than the adolescents who described compelled or no clear pathways to care. Adolescents who described a Compelled pathway were less likely to meet diagnostic criteria for Conduct Disorder and described fewer social network ties. We were unable to find a relationship between pathways classifications and referral source, suggesting these narratives were subjective constructions of pathways to care rather than a factual representation of this process. In the final logistic regression model examining correlates of treatment completion, articulating a pathway to care, whether it was one of agreement or of being compelled into treatment, predicted a greater likelihood of completing treatment. Overall, these narratives and their correlates are highly consistent with the Network-Episode Model's emphasis on the interaction of self, situation, and social network in shaping the treatment seeking process, demonstrating the applicability of this model to understanding the treatment seeking process in this special population and suggests important considerations for understanding the dynamics of service utilization across diverse communities.

[Prevalence of psychiatric disorders in juvenile offenders in the city of Rio de Janeiro (RJ, Brazil)]

The prevalence of juvenile offenders in Brazil, mainly among young females, is on the increase. The literature on this issue indicates an increased incidence of mental disorders among young offenders in several countries, though studies in Brazil are lacking. The aim of this article is to study the prevalence of mental disorders in adolescents from a socio-educational standpoint, taking as a hypothesis the gender difference and the type of offense committed. The instrument used was the K-SADS-PL. As results, we found a high prevalence of psychiatric disorders among juvenile offenders, the most common being: attention deficit hyperactivity disorder (33.3%); behavioral disorder (77%); oppositional defiant disorder (50%), anxiety disorders (70%), depressive disorder (50%), illicit drug abuse/dependence (70%), and alcohol abuse/dependence (52%). Alcohol abuse/dependence caused a 2.4-fold increase in the probability of adolescents committing a violent offence. Public health authorities should concentrate on early diagnosis and treatment of psychiatric disorders in childhood to reduce future violations. It is also suggested that mental health treatment of detained juveniles should be a fundamental part of the recuperation and reintegration of young offenders into society.

Poverty and health disparities for American Indian and Alaska Native children: current knowledge and future prospects

This report explores the current state of knowledge regarding inequalities and their effect on American Indian and Alaska Native children, underscoring gaps in our current knowledge and the opportunities for early intervention to begin to address persistent challenges in young American Indian and Alaska Native children's development. This overview documents demographic, social, health, and health care disparities as they affect American Indian and Alaska Native children, the persistent cultural strengths that must form the basis for any conscientious intervention effort, and the exciting possibilities for early childhood interventions.

Obstacles for rural American Indians seeking alcohol, drug, or mental health treatment

The purpose of this study was to identify factors associated with 4 clusters of obstacles (self-reliance, privacy issues, quality of care, and communication and trust) to mental health and substance abuse treatment in 3 treatment sectors for residents of 3 reservations in the United States. Participants (N=3,084) disclosed whether they had sought treatment for emotional, drug, or alcohol problems in the past year and, if so, whether they had faced obstacles in obtaining care from Indian Health Services, tribal services, and other public or private systems. Correlates of these obstacles included negative social support, instrumental social support, utility of counselors, utility of family doctors, treatment sector, treatment type, diagnosis of an anxiety disorder, and tribe.

Detecting mental disorder in juvenile detainees: who receives services

OBJECTIVES

We determined whether or not juvenile detainees with major mental disorders received treatment, and the variables that predicted who received services.

METHODS

Our sample was 1829 randomly selected juvenile detainees taking part in the Northwestern Juvenile Project. To determine need for mental health services, independent interviewers administered the Diagnostic Interview Schedule for Children and rated functional impairment using the Child Global Assessment Scale. Records on service provision were obtained from the juvenile justice and public health systems.

RESULTS

Among detainees who had major mental disorders and associated functional impairments, 15.4% received treatment in the detention center and 8.1% received treatment in the community by the time of case disposition or 6 months, whichever came first. Significantly more girls than boys were detected and treated. Receiving treatment was predicted by clinical variables (having a major mental disorder or reported treatment history or suicidal behavior) and demographic variables.

CONCLUSIONS

The challenge to public health is to provide accessible, innovative, and effective treatments to juvenile detainees, a population that is often beyond the reach of traditional services.

Effects of alcohol and drug use on inpatient and residential treatment among youth with severe emotional disturbance in Medicaid-funded behavioral health care plans

This study examined the use of alcohol and recreational drugs among 875 youth with severe emotional disturbance (SED) enrolled in Medicaid-funded behavioral health care plans, and whether co-occurring SED and substance use affected the subsequent likelihood of receiving inpatient and/or residential treatment. Youth at five sites nationwide were interviewed about their use of drugs and alcohol, while interviews with their caregivers elicited information about youths' service utilization, degree of functional impairment, and a series of demographic and environmental variables. Results indicated that half of the youth (52%) reported lifetime use of alcohol, street drugs, or over-the-counter medications for recreational purposes, while 18% reported use in the past 30 days. Among those reporting recent use, 32% reported using drugs only, 34% alcohol only, and 33% reported use of both drugs and alcohol. In multivariate logistic regression analyses, the effect of recent use was stronger than that of lifetime use; however, the largest effect occurred for those reporting recent use of both drugs and alcohol, versus either alone, or none. Differences remained significant when controlling for managed care versus fee for service enrollment as well as child, family, and environmental characteristics including study site. These results mirror those of prior studies that found an association between substance use and greater likelihood of inpatient services, even in managed care settings.

Substance abuse, conduct disorder and crime: assessment in a juvenile detention house in Istanbul, Turkey

The purpose of the present study was to determine the rate of substance abuse in the juvenile detention house and to determine the relationship between crime and substance abuse and conduct disorder. Two hundred and thirty cases in the biggest juvenile detention house in Istanbul, Turkey were assessed according to Diagnostic and Statistical Manual of Mental Disorders (4th edn; DSM-IV) criteria. Law files and data of crime were examined. A total of 80 out of 230 juvenile detainees (34.8%) were found to have substance abuse excluding nicotine and alcohol. The substances abused in preferential order were cannabis (72.5%), volatile substances (21.3% bally and 3.7% thinner; 25%) and sedative hypnotic drugs and biperidents (2.5%). The rate of conduct disorder was 46.3% in substance abusers and 25.3% in the others (odds ratio: 2.536). The rate of substance abuse was 48.5% in the juveniles who had committed multiple crimes and 14.1% in the others (odds ratio: 5.735). The study shows that conduct disorder was very high in juvenile detainees. Conduct disorder was higher in substance-abusing than in non-abusing juvenile detainees. Substance-abusing juvenile detainees were found to have a higher detention rate than non-abusing juvenile detainees. There was a close relation between conduct disorder and substance abuse and multiple crimes. In the light of these results, diagnosis and treatment for conduct disorder in juvenile detainees are of great importance.

Mental health assessments in juvenile justice: report on the consensus conference

OBJECTIVE

At national, state, and local levels, there is increasing recognition of the importance of identifying and responding to the mental health needs of youths in the juvenile justice system, as policymakers and practitioners struggle to find ways to address causes and correlates of juvenile crime and delinquency. The proposed guidelines for mental health assessment provide explicit information about how, why, and when to obtain mental health information on justice youths at each important juncture in processing.

METHOD

A national group of expert researchers and practitioners convened in April 2002. Experts derived six recommendations, following the expert consensus method, for conducting mental health assessments in juvenile justice settings. Experts had broad experience creating collaborations between juvenile justice, mental health, and child welfare systems and understood the policy and health implications of conducting such assessments in juvenile justice settings.

RESULTS

Consensus Conference recommendations regarding screening for emergent risk, screening and assessment of mental health service needs, comprehensive mental health assessment components, assessment before community re-entry, need for periodic reassessment, and staff training are presented.

CONCLUSION

Deriving specific recommendations that can be implemented systematically is a necessary first step toward policy changes that will optimize the standard of care for this vulnerable population.

Mental health and medical problems and service use among adolescent substance users

OBJECTIVE

Adolescents entering the substance abuse treatment system frequently exhibit mental health and medical problems. Because little is known about whether these youths receive services to address these problems, this study examined the services received by youths admitted to substance abuse treatment.

METHOD

Admission and 3-month follow-up reports of mental health, medical problems, and service use were examined within a large cohort (N = 1,088) of 12-19-year-olds admitted to seven inpatient and outpatient substance abuse treatment programs across the United States between 1998 and 2001.

RESULTS

High levels of mental health problems were found at both time points, but few received mental health treatment. In contrast, there were lower rates of medical problems, and more than half received services. Logistic regression predicting mental health treatment receipt found females in residential settings with more current and baseline distress to be more likely to receive services. Ethnicity, baseline behavioral problems, and whether or not currently in substance abuse treatment did not predict service use. A logistic regression predicting medical services showed that females in residential treatment were also more likely to receive medical treatment.

CONCLUSION

Although these results require replication and validation, they suggest that more could be done to take advantage of the opportunity to link youths entering substance use treatment with mental health services.

Mental health screening results for Native American and Euro-American youth in Oregon juvenile justice settings

Mental health needs of Native American youth in the Oregon juvenile justice system are compared to those of Euro-American youth. The comparison is between 109 Euro-American youth and 22 Native American youth drawn from two samples of youth adjudicated to community service and incarcerated. The youth completed a mental health history and indices of mental health and health status. Native American youth are disproportionately represented in the Oregon juvenile justice system. Mental health profiles of Native American youth reflect problems at least as severe as those of Euro-American youth, and both Native American and Euro-American youth in the juvenile justice system had profiles different from those of youth not referred for clinical services. More Native American youth (42.5%) compared to Euro-American youth (27.5%) reported considering suicide in the past 12 months. Mental health screenings for both Native American and Euro-American youth are indicated.

Treatment of alcohol use disorders in adolescents

The treatment of alcohol use disorders (AUDs) in adolescents is a very important issue in the field of substance use disorders; however, it is a complex and understudied area in which there are limited data concerning evidence-based treatment. The authors first briefly review the epidemiology of AUDs in adolescents, describe existing guidelines for the treatment of such disorders in adolescent patients, and consider differences between AUDs as they present in adolescents and adults. In the next section of the paper, the authors review the assessment and diagnosis of AUDs in adolescents and consider how findings from such assessments will influence subsequent treatment planning. They also describe prognostic factors (e.g., family issues, socioeconomic factors, psychiatric comorbidity, gender, ability to form a therapeutic alliance) that may affect treatment outcome and need to be considered in treatment selection. The various settings in which adolescent AUDs may be treated and the types of patients and situations for which each is most appropriate are described. The second half of the article focuses on the treatment of adolescents with AUDs. The authors describe techniques for establishing abstinence and then preventing subsequent relapse. Although there is an interest in the use of medications (e.g., naltrexone) to treat AUDs in this population, there are unfortunately few if any data concerning the use of these agents in adolescent patients. More data are available concerning psychosocial treatments. The authors describe a variety of psychosocial modalities that have been tested in adolescents, including individual psychotherapy (e.g., interpersonal therapy, cognitive-behavioral therapy, motivational enhancement therapy), group therapies, 12 step/self-help programs, family therapy, skills training for parents, and psychoeducation. The authors then consider the importance of targeting comorbid psychiatric conditions, especially anxiety and depression, in the treatment of AUDs in adolescents. The authors stress the importance of being aware that adolescents with AUDs are at increased risk for violence against self or others and suicide. They also note that practitioners who work with adolescents with AUDs often need to deal with forensic issues (e.g., DUI charges).

Effects of capitated mental health services on youth contact with the juvenile justice system

OBJECTIVE

To evaluate the association between Medicaid mental health capitation and youth's involvement with the juvenile justice system.

METHOD

A longitudinal, quasi-experimental pre/post design was used. Using administrative databases, juvenile justice contact, defined as any detention or commitment, was assessed for 13,365 Medicaid-eligible youths, aged 10-17 years, who received public mental health services over a 3-year period (1994-1997) in the state of Colorado.

RESULTS

There was no significant effect of financing when secular time was controlled for (interaction financing x time: hazard rate = 0.92, p =.62). The main effects model demonstrates a significant secular trend with juvenile justice contacts decreasing over time for both types of financing (hazard rate = 0.80, p =.002) and a significant effect of financing with eventually capitated sites having higher rates of juvenile justice contact compared with sites that remained fee-for-service (hazard rate = 1.24, p =. 009). Multivariate analyses controlled for demographics, mental health and substance use diagnoses, and other risk factors for juvenile justice contact.

CONCLUSIONS

After adjustment for secular trends, capitation was not associated with a reduction in juvenile justice contact. Nonetheless, these findings provide evidence that capitation did not increase the risk of juvenile justice contact.

The voice DISC-IV with incarcerated male youths: prevalence of disorder

OBJECTIVES

(1) To accurately assess rate of psychiatric disorder in incarcerated juveniles, and (2) to examine the feasibility of using a self-administered, comprehensive structured psychiatric assessment with those youths.

METHOD

In 1999-2000, 292 recently admitted males in secure placement with New Jersey and Illinois juvenile justice authorities provided self-assessments by means of the Voice Diagnostic Interview Schedule for Children-IV, a comprehensive, computerized diagnostic instrument that presents questions via headphones.

RESULTS

Assessments were well tolerated by youths, staff, and parents; 92% of approached youths agreed. Rates of disorder were comparable to prior diagnostic assessment studies with interviewers. Beyond expectable high rates of disruptive and substance use disorders, youths reported high levels of anxiety and mood disorders, with over 3% reporting a past-month suicide attempt. Youths with substance use disorder were significantly more likely to be incarcerated for substance offenses than were youths with no disorder or those with other, non-substance use disorders.

CONCLUSIONS

Although the study identified rates of disorder generally comparable to those of prior investigations, some differences, understandable in the context of measurement variations, are apparent. Those variations offer recommendations for mental health assessment practices for youths in the justice system that would include using a comprehensive self-report instrument, pooling across parent and youth informants for certain disorders, focusing on current disorder, and flexibility regarding consideration of impairment.

Mental health services for American Indians and Alaska Natives: need, use, and barriers to effective care

This special review summarizes and illustrates the state of our knowledge regarding the mental health needs of American Indians and Alaska Natives. These needs are considerable and pervasive. The discussion begins by reflecting on the limits of psychiatric nomenclature and conceptual frameworks for revealing Native constructions of mental health and mental illness. The experience and manifestation of psychopathology can be both different and the same across cultures, hinging upon the extent to which such basic assumptions as the relationship of mind to body--and spirit in the case of Native people--or the primacy of the individual or social collective are shared. Having set the stage, this paper moves to recent empirical evidence regarding the mental health needs of American Indians and Alaska Natives: we review that evidence and consider it within the broader context of available services. The report closes with a brief overview of the most pressing issues and forces for change afoot in Indian country in the US. Most have to do with the structure and financing of care as tribes and other Native community-based organizations seek to balance self-determination and resource management to arrive at effective, fiscally responsible, culturally informed prevention, treatment, and aftercare options for their members. These changes may herald similar trends among First Nations people to the immediate north.

Commentary: quality of alcohol, drug, and mental health services for American Indian children and adolescents

American Indian children and adolescents suffer from a high prevalence of alcohol, drug, and mental (ADM) disorders. Unfortunately, the systems of services for these children and youth have never been able to address adequately their mental health needs. Thus, the revolutionary changes now taking place within these service systems, in particular the marked increase in the direct provision of services by Indian tribes and organizations, provides a unique opportunity to address these historical shortcomings. In this paper, we describe our existing knowledge concerning the quality of ADM services for American Indian children and adolescents and their critical sociodemographic, sociocultural, and epidemiologic contexts. We then consider the implications of these studies for improving the quality of care as well as its measurement and monitoring.