The cross-cutting psychosocial and systemic barriers to holistic rehabilitation,including educational re-engagement,of incarcerated adolescents: Realities in and perspectives from Africa

The present study identifies the potential barriers to holistic rehabilitation, including educational re-engagement, of justice-involved youth in Africa. This was done using quantitative data on the educational and other psychosocial problems presented by a cohort of justice-involved youth and qualitative data on the realities on ground in the correctional school within a youth correctional facility in Lagos, Nigeria, as an illustrative example. Findings showed a lot of cross-cutting psycho-social and systemic barriers to holistic psycho-social rehabilitation of justice-involved adolescents. These include pre-existing psychosocial problems such as, educational disengagement prior to incarceration, high prevalence rates of untreated intercurrent behavioral disorders such as conduct disorders and attention-deficit/ hyperactivity disorder among detained youth, and lack of community- or school-based pre-emptive interventions for school-related indicators of delinquency within the juvenile justice system. Others are lack of non-incarcerating correctional system with focus on psychosocial and educational rehabilitation, poor standard of human/ infrastructural resource-capacity within the facilities, and low level of school-engagement occasioned by poor mental and behavioral health among those enrolled in correctional schools. Context-appropriate pre-emptive and responsive strategies to address cross-cutting psycho-social and rehabilitative needs of justice-involved youth were discussed.     

The relation between dimensions of maltreatment,placement instability,and mental health among youth in foster care

Youth in foster care with maltreatment experiences often demonstrate higher rates of mental and behavioral health problems compared to youth in the general population as well as maltreated youth who remain at home. Previous research has demonstrated that dimensions of maltreatment (type, frequency, and severity) and placement instability are two prominent factors that account for high rates of psychopathology (e.g., depression, anxiety, and disruptive behavior disorders). The present study sought to clarify the relation between maltreatment and mental health among youth in foster care by studying both the isolated dimensions of maltreatment and cumulative maltreatment, and to determine whether the effects of maltreatment on mental health operated indirectly through placement instability. Information on youth in foster care’s (N = 496, M_age = 13.14) mental and behavioral health, maltreatment history, and placement changes were obtained from state records and primary caregivers. Using a SEM framework, the results suggest that maltreatment and placement instability each independently relate to mental and behavioral health problems. Further, none of the maltreatment types predicted greater placement instability in the current models. These findings suggest that placement stability is critical for mental health for youth in foster care, regardless of the type, severity, or frequency of their maltreatment experiences. Results also indicated that, although cumulative maltreatment predicted both internalizing and externalizing symptoms, maltreatment frequency and severity had direct relations to externalizing symptoms only. These findings underscore the utility of comprehensive maltreatment assessment, encouraging researchers and clinicians to assess and carefully consider the relation between maltreatment dimensions and outcomes.     

Parent–youth discordance about youth-witnessed violence: Associations with trauma symptoms and service use in an at-risk sample

ObjectiveStudies have consistently demonstrated a lack of agreement between youth and parent reports regarding youth-witnessed violence. However, little is known about whether disagreement is associated with poorer outcomes and less utilization of mental health services. The purpose of the current study was to examine disagreement among youth and parents about youth witnessed violence, and determine whether concordance predicted trauma symptoms and recognition of need and receipt of counseling services.MethodsConcordance about youth-witnessed violence was examined in 766 dyads from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Youth participants self-reported trauma symptoms, caregivers indicated youth need for and receipt of services. Both youth and parents provided information about youth-witnessed violence exposure in the last year.ResultsResults showed youth and caregivers differed significantly about youth-witnessed violence. Specifically, 42% of youth reported youth-witnessed violence, compared to only 15% of parents. For those parents who reported youth-witnessed violence, only 29% reported an identified need for services and only 17% reported the youth had received any mental health services. Concordance between parent–youth dyads was associated with greater identified need for services but was not associated with the use of counseling services or trauma symptoms.ConclusionsYouth who reported witnessing violence reported more frequent trauma symptoms regardless of concordance. Parents from dyads in which both informants reported youth-witnessed violence were more likely to endorse need for, but not receipt of counseling services. Given this association between youth-witnessed violence and mental health problems, more work is needed to identify barriers to concordance as well as service utilization.     

Coerced and forced sexual initiation and its association with negative health outcomes among youth: Results from the Nigeria,Uganda, and Zambia Violence Against Children Surveys

IntroductionCoerced and forced sexual initiation (FSI) can have detrimental effects on children and youth. Understanding health outcomes that are associated with experiences of FSI is important for developing appropriate strategies for prevention and treatment of FSI and its consequences.MethodsThe Violence Against Children Surveys were conducted in Nigeria, Uganda, and Zambia in 2014 and 2015. We examined the prevalence of FSI and its consequences (sexual high-risk behaviors, violence experiences, mental health outcomes, and sexually transmitted infections (STI)) associated with FSI among youth aged 13–24 years in three countries in sub-Saharan Africa.ResultsOver one in ten youth aged 13–24 years who had ever had sex experienced FSI in Nigeria, Uganda, and Zambia. In multivariable logistic regression, FSI was significantly associated with infrequent condom use (OR = 1.4, 95%CI = 1.1–2.1), recent experiences of sexual violence (OR = 1.6, 95%CI: 1.1–2.3), physical violence (OR = 2.2, 95%CI: 1.6–3.0), and emotional violence (OR = 2.0, 95%CI: 1.3–2.9), moderate/serious mental distress (OR = 1.5, 95%CI: 1.1–2.0), hurting oneself (OR = 2.0, 95%CI: 1.3–3.1), and thoughts of suicide (OR = 1.5, 95%CI: 1.1–2.3), after controlling for demographic characteristics. FSI was not statistically associated with engaging in transactional sex, having multiple sex partners, or having a STI.ConclusionFSI is associated with infrequent condom use, recent experiences of violence and mental health outcomes among youth in sub-Saharan Africa, which may increase the risk for HIV and other consequences. Developing strategies for prevention is important for reducing the prevalence of FSI and its effects on children and youth.     

Suicidality, school dropout, and reading problems among adolescents

The purpose of this study was to examine the risk of suicidal ideation and suicide attempts and school dropout among youth with poor reading in comparison to youth with typical reading (n = 188) recruited from public schools at the age of 15. In a prospective naturalistic study, youth and parents participated in repeated research assessments to obtain information about suicide ideation and attempts, psychiatric and sociodemographic variables, and school dropout. Youth with poor reading ability were more likely to experience suicidal ideation or attempts and more likely to drop out of school than youth with typical reading, even after controlling for sociodemographic and psychiatric variables. Suicidality and school dropout were strongly associated with each other. Prevention efforts should focus on better understanding the relationship between these outcomes, as well as on the developmental paths leading up to these behaviors among youth with reading difficulties.     

Patterns of adversity and pathways to health among White,Black, and Latinx youth

Research has demonstrated the negative impact of Adverse Childhood Experiences (ACEs) on long-term trajectories of mental and physical health. Yet existing literature on this topic is limited in its understanding of outcomes among youth samples, optimal measurement items and methods, and differences in adverse experiences across race/ethnicity. The current study used a person-centered approach to measure ACEs and their impact on youth health outcomes across three different racial/ethnic groups from a large national database. Patterns of exposure to adverse experiences among Black, Latinx, and White youth (N = 30,668, ages 12–17) were determined empirically using latent class analysis (LCA). Significant differences in class membership by demographic indicators (age, household income, sex) and concurrent health outcomes were identified. Different models emerged for Black (2 classes), Latinx (3 classes), and White youth (3 classes). Older and lower-income youth were more likely to have experienced adversities, but there were no differences in adversity likelihood by sex. Additionally, racial/ethnic minority youth were at greater risk of experiencing higher levels of adversity, poverty, and poor health when compared to their White counterparts. Rather than occuring in meaningful clusters, adverse experiences among youth reflected a cumulative risk model such that classes were defined by the overall intensity of adverse experiences (i.e., low, moderate, high). Findings provide greater knowledge regarding the relationship between ACEs and health and future research directions to inform more targeted and culturally-appropriate screening, prevention, and intervention programs.     

Childhood adversity and behavioral health outcomes for youth: An investigation using state administrative data

This study aimed to measure the relative contribution of adverse experiences to adolescent behavioral health problems using administrative data. Specifically, we sought to understand the predictive value of adverse experiences on the presence of mental health and substance abuse problems for youth receiving publicly funded social and health services. Medicaid claims and other service records were analyzed for 125,123 youth age 12–17 and their biological parents. Measures from administrative records reflected presence of parental domestic violence, mental illness, substance abuse, criminal justice involvement, child abuse and/or neglect, homelessness, and death of a biological parent. Mental health and substance abuse status of adolescents were analyzed as functions of adverse experiences and other youth characteristics using logistic regression. In multivariate analyses, all predictors except parental domestic violence were statistically significant for substance abuse; parental death, parental mental illness, child abuse or neglect and homelessness were statistically significant for mental illness. Odds ratios for child abuse/neglect were particularly high in both models. The ability to identify risks during childhood using administrative data suggests the potential to target prevention and early intervention efforts for children with specific family risk factors who are at increased risk for developing behavioral health problems during adolescence. This study illustrates the utility of administrative data in understanding adverse experiences on children and the advantages and disadvantages of this approach.     

Developing a tailored substance use intervention for youth exiting foster care

Youth who are aging out of the foster care system face significant barriers to accessing substance use treatment. Mobile interventions have shown efficacy for several mental and physical health issues and may be helpful in overcoming barriers facing foster youth with substance use problems. A program (iHeLP) for substance use reduction was developed that used a computerized screening and brief intervention (SBI) followed by six months of dynamically-tailored text messages. The program was shown to focus groups of youth (N = 24) ages 18–19 who recently left foster care and had moderate to severe substance use risk. Focus group feedback was used to modify iHeLP prior to delivery in an open trial (N = 16). Both study phases included assessments of feasibility and acceptability; the open trial also included assessments of substance use outcomes at 3 and 6 months. Focus groups indicated a high level of acceptability for the proposed intervention components. Of those screened for the open trial, 43% were eligible and 74% of those eligible enrolled, indicating good feasibility. Retention through the final follow-up was 59%, and drop out was associated with involvement in the criminal justice system. Participant ratings for liking, ease of working with, interest in and respectfulness of the SBI were high. Satisfaction ratings for the texting component were also high. A computerized brief screening intervention for substance use risk reduction together with tailored text messaging is both feasible and highly acceptable among youth who have recently aged-out of foster care.     

Childhood trauma and psychiatric disorders as correlates of school dropout in a national sample of young adults

The effect of childhood trauma, psychiatric diagnoses, and mental health services on school dropout among U.S.-born and immigrant youth is examined using data from the Collaborative Psychiatric Epidemiology Surveys, a nationally representative probability sample of African Americans, Afro-Caribbeans, Asians, Latinos, and non-Latino Whites, including 2,532 young adults, aged 21-29. The dropout prevalence rate was 16% overall, with variation by childhood trauma, childhood psychiatric diagnosis, race/ethnicity, and nativity. Childhood substance and conduct disorders mediated the relation between trauma and school dropout. Likelihood of dropout was decreased for Asians, and increased for African Americans and Latinos, compared to non-Latino Whites as a function of psychiatric disorders and trauma. Timing of U.S. immigration during adolescence increased risk of dropout.     

Post-traumatic stress and related symptoms among juvenile detention residents: Results from intake screening

BackgroundJuvenile justice-involved youth have high rates of trauma exposure, physical and sexual abuse and PTSD. Several factors have been found to be related to PTSD symptoms in youth including number and chronicity of traumatic events.ObjectiveTo simultaneously examine the relationships between allostatic load (defined here as number of traumatic experiences), poly-victimization (exposure to two or more forms of victimization based on 5 of the 6 categories in Ford et al.’s 2010 study), physical/sexual abuse and PTSD in justice-involved youth.Participants and SettingThe sample consisted of 1984 youth in juvenile detention in a Northeastern city. The sample was 73.4% male and the majority of youth were either African American or Hispanic.MethodsClinicians collected demographic and psychosocial information, and measured symptoms of PTSD, depression, and problematic substance use.ResultsResults showed that youth with more traumas, those who experienced poly-victimization and those who experienced physical/sexual assault/abuse were not only more likely to have PTSD, but also more likely to have depression, thoughts of suicide/self-harm, and problematic substance use (as indicated by the presence of 2 or more of 6 possible indicators). Poly-victimization was a stronger correlate of PTSD than number of traumas or physical/sexual assault/abuse. However, among youth with PTSD, number of traumas was associated with co-occurring problems while poly-victimization and physical/sexual assault/abuse were not.ConclusionsFindings can be used to help direct resources to juvenile justice-involved youth who are most in need of treatment.     

Family risk factors and prevalence of dissociative symptoms among homeless and runaway youth

OBJECTIVE: To examine family risk factors associated with dissociative symptoms among homeless and runaway youth. METHOD: Three hundred and twenty-eight homeless and runaway youth were interviewed using a systematic sampling strategy in metropolitan Seattle. Homeless young people were interviewed on the streets and in shelters by outreach workers in youth service agencies. RESULTS: The current study revealed widespread prevalence of dissociative symptoms among these young people. Multivariate analyses revealed that sexual abuse, physical abuse, and family mental health problems were all positively associated with dissociative symptoms. No gender differences were found for any of the models. CONCLUSIONS: Dissociative behavior is widespread among these youth and may pose a serious mental health concern. Some young people experience numerous stressors, and with few resources and little support available, many may invoke maladaptive strategies such as dissociative behavior to handle such situations, which may in turn be detrimental to their mental health. Unless youth are provided with programs and intervention, the cycle of abuse that they have experienced at home is likely to continue on the street.     

Lesbian,gay, and bisexual (LGB) youth within in welfare: Prevalence,risk and outcomes

The purpose of this study was to estimate the population of sexual minority or LGB (lesbian, gay and bisexual) children and youth involved with the child welfare system, and to compare their health, mental health, placement and permanency outcomes to those of non-LGB youth. Data were drawn from the Second National Survey of Child and Adolescent Well-Being (NSCAW-II), a nationally representative sample of children who were referred to child welfare due to a report of abuse or neglect over a fifteen month period. This sample included youth ages eleven and older who self-identified their sexual orientation (n = 1095). Results indicate that approximately 15.5% of all system involved youth identified as lesbian, gay or bisexual, and that lesbian and bisexual females, and LGB youth of color are both overrepresented within child welfare systems. Although no substantive difference in risk factors, permanency and placement were found between LGB and Non-LGB youth, LGB youth were significantly more likely to meet the criteria for adverse mental health outcomes. Implications for child welfare practice and policy are presented, along with recommendations for future research in this area.     

Quality assurance and school‐based mental health services

Clinicians affiliated with expanded school mental health (ESMH) programs provide a range of mental health services for youth in schools. ESMH services offer unique opportunities for collaboration between school psychologists and mental health clinicians from the community to increase the quality of care for youth receiving mental health services. The number of ESMH programs is increasing; therefore, developing quality assurance (QA) activities for these programs is important to document accountability and provide evidence for effectiveness. In this paper, suggestions for phases and objectives for QA programs in ESMH programs and examples of suggested activities are presented. Assessment of the program structure as well as treatment process and outcome are critical phases. Important QA activities include examining staff training activities, assessment of stakeholder perceptions of services, conducting satisfaction surveys, examining therapy process, and investigating treatment outcomes. Results of QA evaluations should inform policy.QA programs need to be developed and the impact of QA activities in enhancing the quality of care provided by clinicians in schools should be evaluated. © 1999 John Wiley & Sons, Inc.     

The Relation Between Callous-Unemotional Traits,Psychosocial Maturity,and Delinquent Behavior Among Justice-Involved Youth

Callous-unemotional (CU) traits are a risk factor for severe and persistent patterns of juvenile delinquency. Given the influence of CU trait assessments in justice-system settings, it is important to determine whether the predictive utility of CU traits is conditional on the absence of protective psychosocial factors. Employing a sample of justice-involved male youth (N = 1,216, M_age = 15.29), this study examined whether psychosocial maturity (PSM) outweighs or attenuates the effect of CU traits on delinquency. Results indicated that youth with high CU traits or low PSM offended more during the year following their first arrest. Additionally, PSM moderated the relation between CU traits and offending, such that higher PSM was associated with less offending but only among low CU youth.     

A review of psychotherapy outcome research: Considerations for school‐based mental health providers

Evaluating psychotherapeutic outcome is an important endeavor given psychology's focus on identifying effective treatments. There is ample evidence to suggest that psychotherapy interventions for children and adolescents are effective. Unfortunately, the child and adolescent psychotherapy outcome literature lags behind the adult‐focused outcome literature in some important areas, as children and adolescents are often viewed as extensions of adults. This review analyzes the pertinent youth meta‐analyses, examining treatment, client, and therapist variables relevant to positive outcomes. We also consider the impact of variables that have received more attention in the adult psychotherapy outcome literature (i.e., the therapeutic alliance, therapist effects, and allegiance effects) and their possible impact on child and adolescent outcomes. Our hope is that this discussion benefits school‐based mental health professionals when discerning what works best with the youth population. © 2010 Wiley Periodicals, Inc.     

Exploratory two-level analysis of individual- and school-level factors on truant youth emotional/psychological functioning

Research on samples of truant adolescents is limited, with little known about mental health problems among truant youths. This study provided an exploratory, multilevel examination of mental health problems for a sample of 300 truant adolescents. Confirmatory factor analysis indicated a single factor of multiple mental health problems at the individual level, but the structure of these problems was not the same at the school level. A number of covariate effects were found at the individual level on the mental health factor. Further, youths attending middle school were more likely to report attention deficit hyperactivity disorder (ADHD) problems than those in high school. Service and practice implications of better understanding school and mental health issues of truant youth are discussed.     

Adverse childhood experiences among youth reported to child welfare: Results from the national survey of child & adolescent wellbeing

The negative influence of adverse childhood experiences (ACEs) on social, emotional, and behavioral (SEB) outcomes are well documented. However, no research to date has examined the effect of ACEs on SEB outcomes in youth who received mental health services after reporting to the child welfare system. This study's analyses of data from the National Survey of Child and Adolescent Well-Being II revealed that the most prevalent ACEs included hospitalization for a medical condition, neglect, and exposures to domestic and community violence. Logistic regression of this data showed that the odds of being diagnosed with internalizing problems increased with age and when sexual abuse was reported. The results also showed that compared to Caucasian youth, Latinos were less likely to be diagnosed with externalizing behaviors, even when sexual abuse had been reported. Contrary to one of this study's hypotheses, mental health service use within the past 18 months increased the odds of being diagnosed with SEB problems. These findings highlight the persistence of SEB problems despite receipt of mental health services. Future research should assess the impact of interventions that aim to mitigate poor SEB outcomes due to ACEs, especially sexual abuse.     

Examining school dropout among rural youth in Honduras: Evidence from a mixed-methods longitudinal study

This study uses longitudinal mixed methods data to examine patterns of dropout among a cohort of 1305 Honduran rural youth from the time they were in 6th grade to the age of 20. Based on our analysis of household and student surveys and in-depth interviews, we find that dropout is a major problem, particularly during transition years and during the first year of upper secondary education. Dropout results from the accumulation of push and pull factors that lead students to question whether it is worthwhile to stay enrolled, as they lack opportunities to convert their schooling into valued outcomes.     

Racial discrimination and the moderating effects of racial and ethnic socialization on the mental health of Asian American youth

This study investigates trajectories of racial discrimination, racial and ethnic socialization (RES), and their interaction effects with social positions (nativity and gender) on mental health. A longitudinal study of 786 Filipino American (FA) and Korean American (KA) youth from the Midwestern United States (M_age.Wave1 = 15) confirmed that discrimination increased and significantly contributed to the upward trend of mental health distress, whereas the impact of RES differed by its type and by ethnicity. For example, promotion of mistrust and ethnic-heritage socialization were protective among U.S.-born FA youth, but for KA youth, preparation for bias was protective regardless of nativity and gender. This study highlights the importance of considering social positions to better understand the role of RES in youth psychological adjustment.