Examining the meaning attached to mental illness and mental health services among justice system-involved youth and their parents

The association between caregiver psychiatric distress and perceived barriers to behavioral health treatment participation for youth in the juvenile legal system

Youth in the juvenile legal system (JLS) evidence high rates of behavioral health concerns but struggle to access services. Given that caregivers are often tasked with helping their child to initiate and persist with services, it seems important to understand how their own well-being impacts their experiences of barriers to treatment participation for their child. The present study examined the link between caregiver (N = 196; 89% female) psychiatric concerns and experiences of treatment barriers among a sample of youth involved in the JLS. A cluster analysis revealed a cluster of caregivers with clinically significant levels of psychiatric distress and a cluster with low levels of psychiatric distress. Hierarchical regression analyses revealed that belonging to the high-distress cluster was predictive of experiencing certain types of barriers to treatment participation. These findings have implications for interventions for addressing barriers to treatment participation for caregivers of legally involved youth.

How do children and adolescents experience healthcare professionals? Scoping review and interpretive synthesis

OBJECTIVE

Explore children's and adolescents' (CADs') lived experiences of healthcare professionals (HCPs).

DESIGN

Scoping review methodology provided a six-step framework to, first, identify and organise existing evidence. Interpretive phenomenology provided methodological principles for, second, an interpretive synthesis of the life worlds of CADs receiving healthcare, as represented by verbatim accounts of their experiences.

DATA SOURCES

Five key databases (Ovid Medline, Embase, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, and Web of Science), from inception through to January 2019, reference lists, and opportunistically identified publications.

ELIGIBILITY CRITERIA

Research articles containing direct first-person quotations by CADs (aged 0-18 years inclusive) describing how they experienced HCPs.

DATA EXTRACTION AND SYNTHESIS

Tabulation of study characteristics, contextual information, and verbatim extraction of all 'relevant' (as defined above) direct quotations. Analysis of basic scope of the evidence base. The research team worked reflexively and collaboratively to interpret the qualitative data and construct a synthesis of children's experiences. To consolidate and elaborate the interpretation, we held two focus groups with inpatient CADs in a children's hospital.

RESULTS

669 quotations from 99 studies described CADs' experiences of HCPs. Favourable experiences were of forming trusting relationships and being involved in healthcare discussions and decisions; less favourable experiences were of not relating to or being unable to trust HCPs and/or being excluded from conversations about them. HCPs fostered trusting relationships by being personable, wise, sincere and relatable. HCPs made CADs feel involved by including them in conversations, explaining medical information, and listening to CADs' wider needs and preferences.

CONCLUSION

These findings strengthen the case for making CADs partners in healthcare despite their youth. We propose that a criterion for high-quality child-centred healthcare should be that HCPs communicate in ways that engender trust and involvement.

In Their Own Words: How Black Teens Define Trauma

Trauma is a subjective phenomenon. However, when examining trauma among low-income, Black teens, it is common to use established clinical criteria as the metric for identifying and evaluating its presence and impact. Little attention has been devoted to exploring how Black youth characterize trauma in their own terms. This qualitative study explored the concept of trauma from the perspectives of 12 low-income, Black teens. Participants' descriptions included death and loss; violence exposure; police harassment, racism, and discrimination; poverty; being stuck in the hood; and being bullied. While some of their descriptions were compatible with traumatic stressors outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), participants also highlighted factors that are not explicitly enumerated in the DSM. Findings present important implications for the development of more culturally and developmentally inclusive discussions of trauma and for clinical practice with low-income, Black youth who are impacted by trauma and adversity.

Mental health in juvenile judges' decision-making: review of literature

OBJECTIVE

The purpose of this study is to provide an overview of the (strength of the) association between mental health aspects in juvenile offenders and the decision-making process of the juvenile judge. In particular, the presence of a mental disorder in the juvenile offender, the presence of a mental health report, and the mental health orientation of the juvenile judge were studied.

METHODS

A literature review was performed in order to identify relevant studies on the basis of three selection criteria: (i) the decision-making process of the juvenile judge concerning juvenile offenders, (ii) the use of quantitative methodology and (iii) the focus on the three mental health aspects.

RESULTS

Eight studies were found to meet the criteria (n=4318). The association between a mental disorder in the juvenile offender, a mental health report, and the decision of the juvenile judge was rather strong. There was no evidence of an association between mental health orientation of the juvenile judge and his/her decision.

DISCUSSION

Mental health aspects seem to be associated with the decision-making process of the juvenile judge. Future research should further examine the association between these aspects and the decision of the juvenile judge, particularly in the subgroup of juvenile offenders with mental disorders.

Adolescents' commitment to continuing psychotropic medication: a preliminary investigation of considerations, contradictions, and correlates

This mixed-method study examines (1) the extent to which fifty adolescents receiving wraparound treatment and prescribed psychotropic medication for various psychiatric disorders report that they would continue taking medication if the decision was entirely their own (termed "medication commitment"); (2) their general subjective experiences with medication; and (3) which medication experiences and clinical, social, and demographic factors are associated with greater medication commitment. We found that most adolescents (62%) would discontinue treatment; these "less committed" youth were more likely to report various negative medication perceptions and experiences in open-ended questions, relative to "committed" youth. Multivariate analysis indicated that significant correlates of commitment to medication were: taking antipsychotic medication, greater perceived family support, and lack of perceived coercion to take the medication; clinical or demographic factors were not significantly related to medication commitment. The results reinforce the importance of addressing youths' concerns about medication and maximizing their participation in treatment decision-making.

Child abuse in young, HIV-positive women: linkages to risk

In this article we explore the lives of young women living with HIV who experienced physical and/or sexual abuse in childhood. Using a modified version of the Life Story Interview, 40 women recruited from HIV clinics in three different states participated in a qualitative interview. Interviews covered abuse experiences, cognitive and emotional consequences of abuse, coping strategies, and sexual behavior and relationships. Overall, these young women had complex abuse histories, often experiencing more than one type of abuse in the context of other difficult life events. Avoidance and substance use were frequently utilized as coping strategies for abuse-related distress. Young women reported sexual and relationship concerns, including avoidance of sex, sexual dysfunction, sex as a trigger for abuse memories, and difficulty establishing intimacy and trust. Relationships between abuse-related reactions and sexual risk behavior, as well as recommendations for interventions, are discussed.