Showing items related by title, author, creator and subject.

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  The System of Care Mental Health Service Experience: Differences in Perceptions between African American and Caucasian Youth and its Impact on Service Use and the Relationship between Receipt of Services and Emotional and Behavioral Symptoms

  Williams, Crystal; Harrington, Donna (2012)

  Racial disparities in adolescent mental health services remain an unrelenting public health problem. The purpose of this study was to understand the differential system of care service utilization patterns and associated symptoms among African American and Caucasian adolescents with serious emotional disturbances (N = 655; M age = 13.7, 60% Caucasian, 63% male). The primary objectives were to: (1) explore differences in perceptions of mental health service experiences at 6-months by race; (2) examine race as a moderator between perceptions of service experiences and receipt of services between 6 and 12 months; and (3) explore mental health symptoms at 12 months as a function of race. Mental health symptoms for a subsample of youth (N = 548) with elevated symptoms were also examined. A secondary data analysis using data from the Comprehensive Community Mental Health Services for Children and Their Families Program (CMHI) and generalized estimating equation (GEE) analyses indicated that (1) African American and Caucasian adolescents did not differ in their overall perceptions of their service experience, (2) race did not moderate perceptions and receipt of services, and (3) race moderated the relationship between receipt of family therapy and externalizing symptoms. The results also showed that use of individual therapy was predicted by race (Caucasian) and greater emotional/behavioral symptoms at baseline, while group therapy was predicated by gender (male) and greater functional impairment at baseline. Adolescents' perceived social support from adults (not peers) predicted fewer internalizing symptoms, and Caucasian adolescents experienced fewer externalizing symptoms. The examination of mental health symptoms for the subsample revealed that race did not moderate receipt of services and symptoms. Instead, perceived social support from adults (not peers) predicted fewer internalizing symptoms, and clinician-client racial match predicted fewer externalizing symptoms. The findings suggest that African American and Caucasian adolescents share similar perceptions of their service experience, yet disparities in service use and symptomatology persist. Further, youth with perceived social support and a clinician-client racial match experience fewer mental health symptoms. Practitioners should assess adolescent's perceived social support upon receipt of treatment, discuss clinician preferences, and explore opportunities to engage African American families in family therapy.
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  Behavioral Health among Foreign-Born and U.S.-Born Emerging Adults: Barriers to Seeking Services, College Enrollment Status, and Service Utilization

  Bessaha, Melissa; Cornelius, Llewellyn Joseph, 1959-; Unick, George Jay (2016)

  Behavioral health problems are a leading cause of disability and a major public health issue in the United States. Compared to other adult age groups, emerging adults aged 18 to 29 experience more behavioral health problems. Although transitioning to adulthood may provide growth opportunities, it can also be a time of increased vulnerability and risk as emerging adults often face challenges in emotional, educational, and professional transitions. The United States has also seen rapid growth in the foreign-born emerging adult population as well as growing health disparities among immigrant and minority groups; however, prior research investigating behavioral health service use of emerging adults has largely been limited to homogeneous samples of college students. Using the Behavioral Model for Vulnerable Populations, this study explored factors associated with patterns of behavioral health service use across a diverse national sample of emerging adults by nativity status (foreign-born, U.S.-born) and college enrollment status (college student, non- student). A subsample of 6,696 emerging adults from the 2012 Agency for Healthcare Research and Quality Medical Expansion Panel Study was used for this study. Multiple hierarchical binomial logistic regression analyses were performed to determine which factors predicted patterns of behavioral health service use among emerging adult groups. Employed (foreign-born) and Black (all groups except foreign-born) emerging adults were less likely to use services compared to unemployed and White emerging adults, respectively. Preference for English language (non-college students), shorter duration in the United States (college students), and having insurance (all groups except foreign-born) was associated with service use. Those with middle and high income backgrounds (college students) were less likely to use services compared to poor students. Having higher perceived mental health status (all groups except college students) and higher general mental health status (all groups) predicted less service use. Although certain factors were consistently predictive of service use among emerging adult groups, there were differences that necessitate further research. Findings clearly portray the need for greater awareness and consideration of factors related to service use on healthcare policy and higher education program initiatives especially as they relate to promoting health equity and successful transition to adulthood.
• Evaluating family preservation services from a community well-being perspective: A time series analysis of Virginia's Comprehensive Services Act for At Risk Youth and Families

  Templeman, Sharon B.; Harrington, Donna (1998)

  Measuring family preservation outcomes has challenged child welfare professionals, policymakers, and researchers for over a decade. Most agree that a change from the traditional service delivery model was warranted, but there is little agreement on a model to replace the traditional model. Defining family preservation services, determining what outcome measures to use other than out of home placement prevention, and deciding how to measure effectiveness are at the center of the debate. This pilot study addresses all three of these issues. In 1993, Virginia was the first state in the US to uniformly legislate a family preservation service system of care. Using the flexible, community-specific, wraparound definition of family preservation services espoused by Virginia's Comprehensive Services Act for At Risk Youth and Families (SA), this study examines the impact of family preservation services on 23 rural Virginia communities. With the community as the unit of analysis and through the use of a hierarchical linear model analysis, four predictors of community well being (low birth weight, school drop out, births to girls, and poverty) were compared with five factors traditionally considered to be risks for children (early school failure, juvenile arrests, child maltreatment, violent teen deaths, and foster care placement). In a time series design, these comparisons were made at six points in time: two years prior to implementation of the CSA, the year the CSA was implemented, and three years after implementation of CSA legislation. The findings in this pilot study demonstrated that the community is an appropriate unit of analysis to study but that evaluation of individual success must also be considered. School drop out rate was found to be a statistically significant predictor of early school failure. Low birth weight and poverty were found to be statistically significant predictors of foster care placement. Measuring change through the use of the two-level hierarchical linear model appears to be a promising model compared to analyses more commonly used in time series designs. Low power due to small sample size and only three years under a new service paradigm signal the need for further study using larger samples and a longer period of observation.