Perceived barriers to mental health services among youths in detention

Do Substances Used in Adolescence Predict the Persistence of Substance Use Disorders in Adulthood? A 15-Year Study of Youth After Detention

PURPOSE

Investigate if the type of substance use disorder (SUD) in adolescence predicts SUDs in adulthood and examine sex and racial/ethnic differences in the persistence of SUDs.

METHODS

Data are from the Northwestern Juvenile Project, a 15-year longitudinal study of 1829 youth randomly sampled from detention in Chicago, IL (1995-1998). Interviewers assessed SUDs using structured diagnostic interviews.

RESULTS

Compared with females without an SUD at detention, females with cannabis alone, comorbid alcohol and cannabis, or SUDs other than alcohol and cannabis at detention had higher odds of having an SUD 5 years later (25%, 32%, and 36% vs. 15%, adjusted odds ratio [AOR] = 1.94, 95% confidence interval [CI] 1.11-3.40; AOR = 2.76, 95% CI 1.58-4.83; AOR = 3.46, 95% CI 1.56-7.66, respectively). Males and females with SUDs other than alcohol and cannabis at detention had greater odds of having an SUD 15 years later, compared with those without an SUD at detention (males: 36% vs. 14%, AOR = 2.98, 95% CI 1.14-7.83; females: 29% vs. 8%, AOR = 4.77, 95% CI 1.85-12.30). Among youth with an SUD at detention, males were more likely than females to have an SUD 15 years later (AOR = 1.84, 95% CI 1.03-3.29); non-Hispanic White and Hispanic males were more likely to persist than Black males (AOR = 3.32, 95% CI 1.50-7.35; AOR = 2.32, 95% CI 1.04-5.18, respectively).

DISCUSSION

The type of SUD during adolescence matters. Youth with SUDs such as cocaine and opioids fared the worst. Healthcare providers must collaborate with correctional officials to increase service provision.

Inequities in Mental Health Services: A 16-Year Longitudinal Study of Youth in the Justice System

OBJECTIVE

To examine: (1) if youth who have mental health disorders receive needed services after they leave detention-and as they age; and (2) inequities in service use, focusing on demographic characteristics and type of disorder.

METHOD

We used data from the Northwestern Juvenile Project, a longitudinal study of 1,829 youth randomly sampled from detention in Chicago, Illinois in 1995. Participants were re-interviewed up to 13 times through 2015. Interviewers assessed disorders using structured diagnostic interviews and assessed service use using the Child and Adolescent Service Assessment and the Services Assessment for Children and Adolescents.

RESULTS

Less than 20% of youth who needed services received them, up to median age 32 years. Female participants with any disorder had nearly twice the odds of receiving services compared with male participants (OR: 1.82; 95% CI: 1.41, 2.35). Compared with Black participants with any disorder, non-Hispanic White and Hispanic participants had 2.14 (95% CI: 1.57, 2.90) and 1.50 (95% CI: 1.04, 2.15) times the odds of receiving services. People with a disorder were more likely to receive services during childhood (< age 18) than during adulthood (OR: 2.29; 95% CI: 1.32, 3.95). Disorder mattered: participants with an internalizing disorder had 2.26 times and 2.43 times the odds of receiving services compared with those with a substance use disorder (respectively, 95% CI: 1.26, 4.04; 95% CI: 1.49, 3.97).

CONCLUSION

Few youth who need services receive them as they age; inequities persist over time. We must implement evidence-based strategies to reduce barriers to services.

Technology Access and Perceptions of Telehealth Services Among Young Adults Involved in the Court System

PURPOSE

This study examined access to technology and telehealth among young adults (ages 18-24) who were court-involved and were recruited from an alternative sentencing program in New York City.

METHODS

Using sequential mixed methods design, we examined demographic factors linked with access to technology and perceived usefulness of the Internet among n = 321 young adults who were court-involved (75% male, 65% African American, 35% Latinx). We then conducted in-depth interviews with 27 young adults to elicit first-person account of their access to, interest in, and experience with technology and telehealth.

RESULTS

Although most participants had access to a phone with a data plan, a substantial proportion reported inconsistent access to the technology critical to telehealth. Certain young adults were more likely to lack consistent access to the technology needed for telehealth, including Black young adults, males, those with less than a high school diploma, those with a history of homelessness, and those who had difficulties paying for basic necessities. Qualitative interviews revealed that most had a strong self-efficacy using technology, while distrust of technology, inexperience with and skepticism of telehealth, low perceived need for care, and medical mistrust were common significant barriers in this underserved population.

DISCUSSION

Findings underscored the critical need to address medical mistrust and increase access to and utilization of care among young adults who are court-involved. Results can inform the development and implementation of interventions designed to improve accessibility and acceptability of telehealth.

Integrated Youth Service Preferences of Caregivers of Justice-Involved Youth: A Discrete Choice Conjoint Experiment

Introduction

Mental health and/or substance use (MHS) challenges affect approximately 95% of youth in the criminal justice system, with only three in ten justice-involved youth receiving treatment. Caregivers of justice-involved youth have identified fragmented care as a barrier to youth accessing MHS services. One suggested solution to this problem is the implementation of integrated youth services (IYS). However, it is unknown which IYS components caregivers of justice-involved youth prioritize.

Methods

Using a discrete choice conjoint experiment (DCE), n = 46 caregivers of justice-involved youth, and n = 204 caregivers of non-justice-involved, completed thirteen choice tasks representing different combinations of IYS.

Results

Both caregiver groups exhibited preferences for involvement and access to information regarding their youth's treatment, and fast access to broad range of core health and additional services, in a community setting, with the incorporation of e-health services. Caregivers of justice-involved youth showed a unique preference for involvement in family counseling with their youth. The incorporation of this service feature may help to engage caregivers of justice-involved youth in their youths' MHS treatment 3-fold.

Conclusion

Data gleaned from this analysis provides an understanding of what components of IYS models may help to engage caregivers of justice-involved youth.

Examining Gender Differences in the Relationship Between School Bonding and Opioid Misuse Among Justice-Involved Adolescents

Justice-involved adolescents (JIAs) have an increased risk for opioid use disorder and overdose related to opioid misuse (OM). Consequences of untreated OM include recidivism and poor educational outcomes, which can be harsher for female JIA. Therefore, identifying relevant factors and settings that reduce the risk for OM is critical. Schools are a central institution in adolescent development. Drawing on social control theory, JIA with higher levels of school bonding was hypothesized to attenuate risk for OM. Cross-sectional data on 79,960 JIA from the Florida Department of Juvenile Justice were examined. Multivariate and stratified logistic regression analyses were employed. On average, for every one-unit increase in school bonding, JIA had 22%, female JIA had 23%, and male JIA had 22% lower odds of OM. Results suggest school bonding and the school context should be considered in treatment and how this setting may impact OM intervention outcomes among JIA.

Exploring Service Use Disparities among Suicidal Black Youth in a Suicide Prevention Care Coordination Intervention

OBJECTIVE

The aim of this study is to examine service utilization disparities among Black youth participating in Linking Individuals Needing Care (LINC), a 90-day research-informed suicide care coordination intervention.

METHODS

An open trial pilot was conducted to examine the effectiveness of LINC in increasing access to and engagement in mental health and non-mental health services among suicidal youth (N = 587). Other variables of interest included service use facilitators and service use barriers. Generalized linear mixed models with binomial distribution and logit link were performed to ascertain if service use facilitators and barriers were associated with service utilization and if disparities in service use and engagement existed between Black and White suicidal youth through a comparative analysis.

RESULTS

Service utilization differences were found between Black and White youth. While Black and White youth were both likely to engage in individual therapy (OR = 1.398, p < .001) and non-mental health services (OR = 1.289, p < .001), utilization rates for mental health and medication management services were lower for Black (55.1% to 60.6%) youth compared to White (66.0% to 71.0%) youth. Specifically, Black youth were significantly less likely than Whites to receive medication management (OR = .466, p = .002). Systemic barriers such long waitlists for care (OR = 1.860, p = .039) and poor relationship with providers (OR = 7.680, p = .028) increased odds of engagement in non-mental health services. Clinical disorders and engagement in suicide-related behaviors increased the likelihood of obtaining care from both medication management and non-mental health services.

CONCLUSION

Care coordination services for suicidal youth can increase access and engagement in mental health and non-mental health services. Culturally adapted models attending to cultural and social assets of Black families are needed to reduce disparities and suicide risk among Black youth.

Conceptualizing Community Mental Health Service Utilization for BIPOC Youth

Historically, children and adolescents who identify as Black, Indigenous, and other people of Color (BIPOC) have had inequitable access to mental healthcare, and research shows that they are significantly less likely than their white American counterparts to utilize available services. Research identifies barriers that disproportionately impact racially minoritized youth; however, a need remains to examine and change systems and processes that create and maintain racial inequities in mental health service utilization. The current manuscript critically reviews the literature and provides an ecologically based conceptual model synthesizing previous literature relating to BIPOC youth barriers for service utilization. The review emphasizes client (e.g. stigma, system mistrust, childcare needs, help seeking attitudes), provider (e.g. implicit bias, cultural humility, clinician efficacy), structural/organizational (clinic location/proximity to public transportation, hours of operation, wraparound services, accepting Medicaid and other insurance-related issues), and community (e.g. improving experiences in education, the juvenile criminal-legal system, medical, and social service systems) factors that serve as barriers and facilitators contributing to disparities in community mental health service utilization for BIPOC youth. Importantly, we conclude with suggestions for dismantling inequitable systems, increasing accessibility, availability, appropriateness, and acceptability of services, and ultimately reducing disparities in efficacious mental health service utilization for BIPOC youth.

Impact of implementation interventions to improve substance use service delivery on recidivism among justice-involved youth

Substance use disorders (SUD) are prevalent among justice-involved youth (JIY) and are a robust predictor of re-offending. Only a fraction of JIY with substance use problems receive treatment. This paper describes the impacts of system-level efforts to improve identification and referral to treatment on recidivism of JIY. A cluster randomized trial involving 20 county juvenile justice agency sites across 5 states was used to implement an organizational intervention (Core vs Enhanced) to juvenile justice staff and community-based treatment providers, working with 18,698 JIY from March 2014 to August 2017. Recidivism rates over four study time periods were examined. Logistic regression was used to predict recidivism as a function of site, need for SUD services, level of supervision, time, organizational intervention, and time x intervention interaction terms. Results indicated that Enhanced sites showed decreased levels of recidivism compared to Core-only sites, where it increased over time. Additionally, need for SU services, level of supervision, and site were significant predictors of reoffending. Findings suggest the potential value of facilitation of juvenile justice agency efforts to increasing identification of and referral to SUD services of JIY in need of such services for reducing further contact with the legal system.

Using structured implementation interventions to improve referral to substance use treatment among justice-involved youth: Findings from a multisite cluster randomized trial

INTRODUCTION

Youth involved in the justice system have high rates of alcohol and other drug use, but limited treatment engagement. JJ-TRIALS tested implementation activities with community supervision (CS) and behavioral health (BH) agencies to improve screening, identification of substance use service need, referral, and treatment initiation and engagement, guided by the BH Services Cascade and EPIS frameworks. This paper summarizes intervention impacts on referrals to treatment among youth on CS.

METHODS

This multisite cluster-randomized trial involved 18 matched pairs of sites in 36 counties in seven states randomly assigned to core or enhanced conditions after implementing the core intervention at all sites for six months. Enhanced sites received external facilitation for local change team activities to reduce unmet treatment needs; Core sites were encouraged to form interagency workgroups. The dependent variable was percentage referred to treatment among youth in need (N = 14,012). Two-level Bayesian regression assessed factors predicting referral across all sites and time periods. Generalized linear mixed models using logit transformation tested two hypotheses: (H1) referrals will increase from baseline to the experimental period, (H2) referral increases will be larger in enhanced sites than in core sites.

RESULTS

Although the intervention significantly increased referral, condition did not significantly predict referral across all time periods. Youth who tested drug positive, had an alcohol/other drug-related or felony charge, were placed in secure detention or assigned more intensive supervision, or who were White were more likely to be referred. H1 (p < .05) and H2 (p < .0001) were both significant in the hypothesized direction. Interaction analyses comparing site pair differences showed that findings were not consistent across sites.

CONCLUSIONS

The percentage of youth referred to treatment increased compared with baseline overall, and enhanced sites showed larger increases in referrals over time. However, variations in effects suggest that site-level differences were important. Researchers should carry out mixed methods studies to further understand reasons for the inconsistent findings within randomized site pairs, and how to further improve treatment referrals across CS and BH systems. Findings also highlight that even when CS agencies work collaboratively with BH providers to improve referrals, most justice-involved youth who need SU services are not referred.

Black Youth Suicide Crisis: Prevalence Rates, Review of Risk and Protective Factors, and Current Evidence-Based Practices

Suicide is the second leading cause of death among adolescents and young adults. Historically, Black youths have experienced lower rates of suicide; however, recent data point to significant racial disparities. In this article, the authors review current suicide rates, including alarming new data suggesting that suicide rates are two times higher among Black children ages 5-12 compared with White children in that age range. A clinically focused summary of socioecological risk and protective factors associated with suicide among Black youths, with particular attention on structural drivers and culturally relevant factors, is provided. Current evidence-based reviews suggest that dialectical behavior therapy is the only well-established treatment against self-harm and suicide among youths. However, it is unknown whether current established treatments work for Black youths, because Black youths are rarely included in randomized controlled trials. The authors conclude by reviewing emerging treatments developed and tested specifically for Black youths.

Factors Influencing Formal Mental Treatment - Seeking Behaviour among Caretakers of Mentally Ill Patients in Zanzibar

Background

Mental illnesses are health conditions which are associated with changes in emotion, thinking, or behaviour (or a combination of these). Healthcare-seeking behaviour for formal mental health treatment is lacking all over the world, particularly in low and middle-income countries. Inappropriate health-seeking behaviours are reported to result in delays in seeking appropriate care and thus increase the risk of complications in mentally ill patients. The study aimed to assess factors influencing formal mental treatment-seeking behaviour among caretakers of mentally ill patients in Zanzibar.

Methods

A community-based cross-sectional study design was conducted from January to June, 2021. A total of 246 caretakers of mentally ill patients were recruited for the study using multi-stage sampling technique. An interviewer-administered semi-structured questionnaire was used to collect information from caretakers. Bivariate and multivariable logistic regression models were applied to determine the factors influencing formal mental treatment-seeking behaviour.

Results

Majority of caretakers 187(76%) were aware of formal mental treatment. Also, majority of the participants 145(58.9%) had appropriate healthcare-seeking behaviour toward formal mental treatment. Factors influencing formal mental treatment-seeking behaviour were; perceived severity (AOR 4.651 at 95% CI 2,397-9.021 p<.001) and being aware (AOR 2.907at 95% CI 2.349-2.326 p=.004).

Conclusion

Majority of caretakers were aware of formal mental illness treatment. Also, more than half of the caretakers had appropriate healthcare-seeking behaviour. Factors associated with formal mental treatment-seeking behaviour were awareness of formal mental treatment and perceived severity of mental illness. The study recommends a community sensitisation campaign to raise community awareness and perception towards formal mental treatment. Community sensitisation is crucial for improving formal mental treatment-seeking behaviour.

Achieving Juvenile Justice through Abolition: A Critical Review of Social Work’s Role in Shaping the Juvenile Legal System and Steps toward Achieving an Antiracist Future

The first juvenile court was created in 1899 with the help of social workers who conceptualized their actions as progressive. Youth were deemed inculpable for certain actions since, cognitively, their brains were not as developed as those of adults. Thus, separate measures were created to rehabilitate youth who exhibited delinquent and deviant behavior. Over one hundred years later, we have a system that disproportionately arrests, confines, and displaces Black youth. This paper critiques social work’s role in helping develop the first juvenile courts, while highlighting the failures of the current juvenile legal system. We then use P.I.C. abolition as a theoretical framework to offer guidance on how social work can once again assist in the transformation of the juvenile legal system as a means toward achieving true justice.

Ecological systems in relation to Latinx youth in the juvenile justice system: A narrative literature review

We conducted a narrative review of literature focused on Latinx youth in the Juvenile Justice System (JJS). The goal of this review was to identify the behavioral health needs and social and cultural factors that place Latinx youth at disproportionate risk for contact and entrenchment with the JJS. Ecodevelopmental Theory (ET) was used as the guiding framework for this review, and a total of 16 peer reviewed articles from Embase, PsychINFO, and Pubmed were collected, analyzed, and summarized. Consistent with ET, we organized themes from the literature into the following sections: (a) microsystem (i.e., family, psychiatric care, sexual health care, school); (b) mesosystem (i.e., family and social environment); (c) exosystem (i.e., family and neighborhood context, and bicultural stress); and (d) macrosystem (i.e., generational status, cultural stress, social class). Sociopolitical disparities, such as disproportionate sentencing by social class and trauma stemming from political violence, and intersections of cultural variables (e.g., generational status and acculturation) should be closely considered in any prevention and intervention efforts targeting Latinx youths. More research to understand and address the unique needs of this population is also needed.

Turning Back to Treatment: The Effect of Attendance and Symptom Outcomes on Subsequent Service Use

This study explored whether post-treatment symptom severity moderated the association between session attendance during an initial treatment episode and subsequent mental health service use. Data on attendance, symptom severity, and service use were gathered from an effectiveness trial testing a modular treatment for youth anxiety, depression, disruptive behavior, and traumatic stress. Multilevel logistic regression analyses showed a significant interaction between attendance and post-treatment symptom severity on subsequent service use, such that attendance significantly predicted subsequent service use when post-treatment symptom severity was in the normal range. Implications regarding the influence of treatment engagement on future help-seeking are discussed.

The health of adolescents in detention: a global scoping review

Adolescents detained within the criminal justice system are affected by complex health problems, health-risk behaviours, and high rates of premature death. We did a global synthesis of the evidence regarding the health of this population. We searched Embase, PsycINFO, Education Resources Information Center, PubMed, Web of Science, CINCH, Global Health, the Cochrane Database of Systematic Reviews, the Campbell Library, the National Criminal Justice Reference System Abstract Database, and Google Scholar for peer-reviewed journal articles, including reviews, that reported the prevalence of at least one health outcome (physical, mental, sexual, infectious, and neurocognitive) in adolescents (aged <20 years) in detention, and were published between Jan 1, 1980, and June 30, 2018. The reference lists of published review articles were scrutinised for additional relevant publications. Two reviewers independently screened titles and abstracts, and three reviewed full texts of relevant articles. The protocol for this Review was registered with PROSPERO (CRD42016041392). 245 articles (204 primary research articles and 41 reviews) were included, with most primary research (183 [90%]) done in high-income countries. A high lifetime prevalence of health problems, risks, and conditions was reported in detained adolescents, including mental disorders (0–95%), substance use disorders (22–96%), self-harm (12–65%), neurodevelopmental disabilities (2–47%), infectious diseases (0–34%), and sexual and reproductive conditions (pregnant by age 19 years 20–37%; abnormal cervical screening test result 16%). Various physical and mental health problems and health-risk behaviours are more common among adolescents in detention than among their peers who have not been detained. As the social and structural drivers of poor health overlap somewhat with factors associated with exposure to the criminal justice system, strategies to address these factors could help to reduce both rates of adolescent detention and adolescent health inequalities. Improving the detection of mental and physical disorders, providing appropriate interventions during detention, and optimising transitional health care after release from detention could improve the health outcomes of these vulnerable young people.

Factors Associated With Use of Mental Health and Substance Use Treatment Services by Justice-Involved Youths

OBJECTIVE

Nonincarcerated (community-supervised) youths who are first-time offenders have high rates of mental and substance use disorders. However, little is known about their use of psychiatric services (mental health and substance use) or factors associated with service use. This study examined the prevalence, determinants, and barriers to service use among community-supervised youths.

METHODS

Data were from a longitudinal study of mental health and substance use outcomes among adolescents ages 12-18 from a northeastern family court in which caregivers and youths completed assessments (N=423 dyads). The Behavior Assessment System for Children, Second Edition, assessed youths' psychiatric symptoms. The Child and Adolescent Services Assessment assessed service use and barriers. Family functioning and caregiver-adolescent communication were assessed with the McMaster Family Assessment Device and the Parent-Adolescent General Communication Scale, respectively. Multivariable regression analyses examined the cross-sectional relationship between youths' service use and determinants of use at baseline.

RESULTS

Of the 423 youths, 49% experienced psychiatric symptoms and 36% used psychiatric services in the past 4 months. The highest adjusted odds of service use were associated with youths' psychiatric symptoms and caregivers' history of a psychiatric diagnosis. The lowest odds were associated with caregivers' identifying as being from racial and ethnic minority groups. Caregiver-reported barriers to service use differed according to prior service use and by caregiver race-ethnicity.

CONCLUSIONS

Results suggest a need for interventions to increase access to and engagement in psychiatric services for community-supervised youths and the importance of caregiver factors in designing such interventions.

Depression in Justice-involved Youth

Justice-involved youth are at exceedingly high risk of trauma exposure, multisystem involvement, and mental health distress, including depression. Justice-involved youth carry with them both a high symptom burden and a high cost to society. Both could be reduced through evidence-based prevention and treatment strategies. Effective treatment of mental disorders may reduce future justice involvement, whereas lack of treatment increases likelihood of justice involvement into adulthood. Multiple effective programs exist to improve the lives of justice-involved youth and subsequently decrease the cost to society of detaining and adjudicating these youth within the juvenile justice system.

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.

Adaptación y Validación del Cuestionario de Barreras para la Búsqueda de Ayuda para Problemas de Salud Mental, en Adolescentes chilenos

La presente investigación tuvo como objetivo, adaptar y validar en adolescentes chilenos, el cuestionario de barreras para la búsqueda de ayuda para problemas de salud mental, versión breve (BASH-B). Este cuestionario mide las barreras o razones percibidas por los adolescentes para no buscar ayuda profesional cuando presentan algún problema psicológico. Los participantes fueron 387 adolescentes de entre 14 y 19 años (M = 15.71 años), escolarizados en establecimientos de enseñanza media de la comuna de Talca (Chile). Se analizaron las propiedades psicométricas del instrumento. El análisis confirmatorio corroboró la estructura factorial unidimensional. Además, los índices de confiabilidad fueron adecuados. La escala presentó asociación significativa con las variables depresión y autoeficacia en las direcciones esperadas. En base a estos resultados, es posible decir que el BASH-B es un instrumento que posee propiedades psicométricas adecuadas para medir las barreras de la búsqueda de ayuda en el ámbito de la salud mental en adolescentes.

Traumatic Stress Among Seriously Delinquent Youth: Considering the Consequences of Neighborhood Circumstance

Myriad factors have been found to have an impact on delinquent behavior and traumatic stress. This study proposes a model that tests the relationship between common predictors of delinquency (neighborhood condition, antisocial peer socialization, and exposure to violence) with traumatic stress. Serial mediation was used to test the relationships between these predictors and traumatic stress. Results indicate the mediation effect between neighborhood conditions and traumatic stress significantly reduces the total effect. Implications for traumatic stress in the context of delinquent behavior are discussed.

Improving Rehabilitative Efforts for Juvenile Offenders Through the Use of Telemental Healthcare

The use of videoconferencing technology in the provision of mental health services is expected to increase rapidly over the next several years. Given the high rates of juvenile offenders in need of such services and the new norms of communication among young people in general, technology-based service modalities are a promising approach for increasing the availability and intensity of services, as well as engagement and compliance with treatment recommendations. This article will discuss the current state of the juvenile justice system, the literature on the use of telemental healthcare (TMH) with delinquent youth, how TMH fits within the generally accepted model of correctional rehabilitation, and special considerations for applying TMH to this population and setting. Although there is no evidence to suggest negative outcomes associated with TMH, future research is greatly needed to justify its use.

Complex health needs in the youth justice system: a survey of community-based and custodial offenders

PURPOSE

Estimate the prevalence and annual frequency of health risk indicators in young people serving community-based orders (CBOs) and custodial orders in the state of Victoria, Australia.

METHODS

Cross-sectional survey of 242 young people serving CBOs and 273 serving custodial orders in Victoria in 2002-2003. Validated measures included the Composite International Diagnostic Interview for substance dependence, Short Mood and Feelings Questionnaire for depression, and Psychosis Screening Questionnaire for psychosis symptoms. Prevalence estimates were adjusted for sampling bias and age- and sex-adjusted for between-group comparisons. Prevalence estimates were applied to 2010-2011 Victorian youth justice data to estimate annual frequencies at the state level.

RESULTS

The prevalence of substance dependence, poor mental health, and risky sexual behavior was high in both groups. Age- and sex-adjusted prevalence estimates were generally higher among those serving custodial orders; however, extrapolating prevalence estimates to statewide youth justice data generally resulted in higher estimated annual frequencies among CBOs. For example, the estimated prevalence of any substance dependence was 66% (95% confidence interval [CI], 60-72) in those serving custodial orders and 34% (95% CI, 26-42) in CBOs, but the estimated frequency of substance dependence in CBOs in 2010-2011 was 970 (95% CI, 750-1,180), compared with 490 (95% CI, 450-530) in those serving a custodial order.

CONCLUSIONS

There is a compelling case for scaling up health services for young offenders in custody and in the community, and for routinely monitoring the health of young offenders serving custodial and community orders.

The blurred vision of Lady Justice for minors with mental disorders: records of the juvenile court in Belgium

PURPOSE

This study examined (1) the information present in juvenile court records in Belgium (Flanders) and (2) whether there are differences in information between records that mention a mental disorder and those that do not.

METHOD

The file study sample included 107 court records, and we used a Pearson's chi-square test and a t-test to analyze the information within those records.

RESULTS

Information in juvenile court records varied considerably. This variability was evident when we compared juvenile court records with and without mention of a mental disorder. Significantly more information about school-related problems, the functioning of the minor, and the occurrence of domestic violence was included in records that mentioned a mental disorder compared with records that did not.

CONCLUSION

The content of the juvenile court records varied, particularly with regard to the mental health status of the minor in question. We suggest guidelines to standardize the information contained in juvenile court records.

Connection to mental health care upon community reentry for detained youth: a qualitative study

BACKGROUND

Although detained youth evidence increased rates of mental illness, relatively few adolescents utilize mental health care upon release from detention. Thus, the goal of this study is to understand the process of mental health care engagement upon community reentry for mentally-ill detained youth.

METHODS

Qualitative interviews were conducted with 19 youth and caregiver dyads (39 participants) recruited from four Midwest counties affiliated with a state-wide mental health screening project. Previously detained youth (ages 11-17), who had elevated scores on a validated mental health screening measure, and a caregiver were interviewed 30 days post release. A critical realist perspective was used to identify themes on the detention and reentry experiences that impacted youth mental health care acquisition.

RESULTS

Youth perceived detention as a crisis event and having detention-based mental health care increased their motivation to seek mental health care at reentry. Caregivers described receiving very little information regarding their child during detention and felt "out of the loop," which resulted in mental health care utilization difficulty. Upon community reentry, long wait periods between detention release and initial contact with court or probation officers were associated with decreased motivation for youth to seek care. However, systemic coordination between the family, court and mental health system facilitated mental health care connection.

CONCLUSIONS

Utilizing mental health care services can be a daunting process, particularly for youth upon community reentry from detention. The current study illustrates that individual, family-specific and systemic issues interact to facilitate or impair mental health care utilization. As such, in order to aid youth in accessing mental health care at detention release, systemic coordination efforts are necessary. The systematic coordination among caregivers, youth, and individuals within the justice system are needed to reduce barriers given that utilization of mental health care is a complex process.

"Straight up": enhancing rapport and therapeutic alliance with previously-detained youth in the delivery of mental health services

A strong therapeutic alliance has been shown to improve mental health treatment outcomes in adults, but this topic has not been fully explored with youth. Adolescents, particularly justice-involved youth, stand to benefit greatly from an improved treatment experience. One quality which can improve treatment is mental health providers' interpersonal skills when attempting to build a therapeutic rapport with adolescent clients. Semi-structured interviews were conducted with 19 youth who screened positive for mental health concerns while in juvenile detention. Four themes were identified as important to improving the therapeutic alliance: Empathy, client-directed care, sequencing, and positive rapport. Suggestions for strengthening a therapeutic alliance are provided.

Psychiatric medication refill practices of juvenile detainees

To examine the psychiatric medication fill rates of adolescents after release from juvenile detention. The team reviewed 177 charts. A fill was defined as a psychiatric medication charge to Medicaid 30- or 90-days after release. Differences in demographic characteristics were compared among individuals with fills at 30- or 90-days and those with no medication fills. Forty-five percent of patients were on at least one psychiatric medication. Among detainees on a psychiatric medication, 62 % had a fill by 30 days after release, and 78 % by 90 days. At least 50 % of the adolescents on a psychiatric medication were on an atypical antipsychotic. There was no significant relationship between medication fill and race, age, or sex. Despite the known associations between mental health diagnosis and treatment-seeking with age, sex, and race, it appears that psychiatric medication fill patterns after release from detention are not associated with these factors.

Pathways to early violent death: the voices of serious violent youth offenders

Quantitative studies have uncovered factors associated with early violent death among youth offenders detained in the juvenile justice system, but little is known about the contextual factors associated with pathways to early violent death among youths detained in adult jails. We interviewed young Black male serious violent youth offenders detained in an adult jail to understand their experience of violence. Their narratives reveal how the code of the street, informal rules that govern interpersonal violence among poor inner-city Black male youths, increases the likelihood of violent victimization. Youth offenders detained in adult jails have the lowest rate of service provision among all jail populations. We have addressed how services for youth offenders can be improved to reduce the pathways to early violent death.

Barriers and facilitators to mental health help-seeking for young elite athletes: a qualitative study

BACKGROUND

Adolescents and young adults experience a high level of mental disorders, yet tend not to seek help. Research indicates that there are many barriers and facilitators to help-seeking for young people in the general community. However there are limited data available for young elite athletes. This study aims to determine what young elite athletes perceive as the barriers and facilitators to help-seeking for common mental health problems.

METHODS

Fifteen elite athletes aged 16-23 years each participated in one of three focus group discussions. In addition to written data, verbal responses were audio taped, transcribed and thematically analysed.

RESULTS

Participants' written and verbal data suggested that stigma was the most important perceived barrier to seeking help for young elite athletes. Other notable barriers were a lack of mental health literacy, and negative past experiences of help-seeking. Facilitators to help-seeking were encouragement from others, having an established relationship with a provider, pleasant previous interactions with providers, the positive attitudes of others, especially their coach, and access to the internet.

CONCLUSIONS

Intervention strategies for improving help-seeking in young elite athletes should focus on reducing stigma, increasing mental health literacy, and improving relations with potential providers.

A qualitative study of relationships among parenting strategies, social capital, the juvenile justice system, and mental health care for at-risk African American male youth

For many poor, African American families living in the inner city, the juvenile justice system has become a de facto mental health service provider. In this article, longitudinal, ethnographic study methods were used to examine how resource-deprived, inner-city parents in a New York City community relied on the juvenile justice system to provide their African American male children with mental health care resources. The results of three case studies indicate that this strategy actually contributed to an escalation in delinquency among the youth.

The role of MDMA (Ecstasy) in coping with negative life situations among urban young adults

This article examines the role of Ecstasy (MDMA or 3, 4-methylenedioxymethamphetamine) as a drug used for self-medication and coping with both short- and long-term negative life situations. We show that urban youth who do not have a specific diagnosed mental illness are more likely than those who have been diagnosed and have received treatment to use Ecstasy to cope with both situational stress and lifetime trauma. Diagnosed and treated youth sometimes self-medicate with other drugs, but do not choose Ecstasy for mediation of their psychological stress. We discuss the implications of self-medication with Ecstasy for mental health services to urban youth experiencing mental health disparities, and for the continued testing and prescription of MDMA for therapeutic use in controlled clinical settings.

Knowledge of and Attitudes Towards Behavioral Health Services Among Older Youth in the Foster Care System

This study examined knowledge of and attitudes toward services among 268 17-year olds with psychiatric diagnoses preparing to exit foster care. A structured interview assessed knowledge of services with vignette scenarios and attitudes with a standardized scale. Descriptive statistics described the extent of knowledge and attitudes among this population and regression analyses examined predictors of these dimensions of literacy. Most youth suggested a help source, but responses often lacked specificity. Gender and depression were the strongest predictors of knowledge and attitudes, respectively. Knowing which aspects of literacy are low, and for whom, can inform education efforts to improve access to care in adulthood.

Disparities in treatment for substance use disorders and co-occurring disorders for ethnic/racial minority youth

OBJECTIVE

To review the literature on racial and ethnic disparities in behavioral health services and present recent data, focusing on services for substance use disorders (SUD) and comorbid mental health disorders for children and adolescents.

METHOD

A literature review was conducted of behavioral health services for minority youth. Articles were included if specific comparisons in receipt of SUD services for youth were made by race or ethnicity. The review was organized according to a sociocultural framework.

RESULTS

Compared with non-Latino Whites with SUD, Black adolescents with SUD reported receiving less specialty and informal care, and Latinos with SUD reported less informal services. Potential mechanisms of racial and ethnic disparities were identified in federal and economic health care policies and regulations, the operation of the health care system and provider organization, provider level factors, the environmental context, the operation of the community system, and patient level factors. Significant disparity decreases could be achieved by adoption of certain state policies and regulations that increase eligibility in public insurance. There is also a need to study how the organization of treatment services might lead to service disparities, particularly problems in treatment completion. Institutional and family characteristics linked to better quality of care should be explored. Because treatments appear to work well independent of race/ethnicity, translational research to bring evidence-based care in diverse communities can bolster their effectiveness.

CONCLUSIONS

This review suggests promising venues to decrease ethnic and racial disparities in behavioral health services for ethnic and racial minority youth.

Mental health literacy among young people in a small US town: recognition of disorders and hypothetical helping responses

AIM

Mental health literacy may be a factor in early detection and prompt treatment for mental, emotional and behavioural disorders among young people. Building on previous research in Australia, this study assessed aspects of mental health literacy among adolescents in classrooms in a small town in the eastern USA.

METHODS

The students were provided brief, hypothetical, gender-matched scenarios about adolescents experiencing negative emotions and exhibiting related behaviours; some scenarios depicted diagnosable disorders. The respondents were asked to characterize each scenario as describing a mental health problem or other teen problem and indicate how they would respond to a peer who had such a problem.

RESULTS

Overall levels of recognition of mental disorders were low (27.5% identified anxiety and 42.4% identified depression as 'a mental health problem or illness'). However, the respondents who recognized a disorder were three to four times more likely than those who did not to say they would take some helping action, such as telling an adult about the problem (depression: odds ratio 3.27; CI 1.43-7.46, anxiety: OR 4.43; CI 2.23-8.79). Few students (27.7%) remembered in-class discussions of mental health, a mandated health topic for schools in their area.

CONCLUSIONS

There appears to be substantial room for improvement in mental health literacy among young people, and the development of interventions to enhance mental health literacy among students may be justified.

Brief report: Need for autonomy and other perceived barriers relating to adolescents' intentions to seek professional mental health care

The current study examined the relationship between belief-based barriers to seeking professional mental health care and help-seeking intentions in a sample of 1037 adolescents. From early adolescence to adulthood, for males and females, the need for autonomy was a strong barrier to seeking professional mental health care. Help-seeking fears were weaker in the older age groups. Having lower perceived need for autonomy and believing that prior mental health care was helpful was significantly associated with higher intentions to seek future professional mental health care. Implications for prevention and overcoming barriers to seeking mental health care are suggested.

Mental health problems in youths committed to juvenile institutions: prevalences and treatment needs

Many international studies show that adolescents in coercive institutional care display high prevalences of mental disorders, especially in the form of disruptive behavior disorders [including attention-deficit/hyperactivity disorder (AD/HD), oppositional defiant disorder, and conduct disorder], anxiety disorders, and mood disorders. High degrees of overlap across mental disorders have also been reported. In addition, institutionalized adolescents are often traumatized. Despite this well-documented psychiatric morbidity, the mental health care needs of detained adolescents are often overlooked. The main objective of this study is to assess prevalences of psychiatric disorders, results of intelligence tests, and previous contacts with child and adolescent psychiatric services among adolescents in institutional care. DSM-IV diagnoses, mental health contacts, substance abuse, neurocognitive abilities, and school performance were registered in 100 adolescents (92 boys, 8 girls) aged 12-19 years (mean age 16.0; SD ± 1.5) consecutively committed to Swedish juvenile institutions between 2004 and 2007. At least one psychiatric disorder was diagnosed in 73% of the subjects: 48% met DSM-IV diagnostic criteria for AD/HD, 17% for an autism spectrum disorder, and 10% for a mental retardation. The collapsed prevalence for psychiatric disorders requiring specialist attention was 63%. Our data indicate that systematic diagnostic procedures are crucial in the treatment planning for institutionalized adolescents. Adequate treatment strategies need to be designed and implemented to meet the extensive mental health care needs of this vulnerable population.