An analysis of stressors and co-morbid mental health problems that contribute to youth's paths to substance-specific services.

Substance-specific services are tailored to address the inappropriate use of chemicals such as alcohol and marijuana. Unfortunately, few teens ever access such need-based services. This article explores the paths to substance-specific service use in a sample of urban adolescents who are public service sector users: a direct path from substance misuse and an indirect path from general mental health service use. Results indicate that even though a significant percentage of youths frequently consume substances and display negative use-related behaviors, few actually received substance-specific services. Contributors to the substance misuse path included youths' family substance dependence and environmental stressors. Contributors to the mental health services path were comorbid depression and substance misuse.

Untangling the impact of sexual abuse on HIV risk behaviors among youths in foster care.

This study investigates the interrelationships among childhood sexual abuse, other types of child maltreatment, emotional and behavioral problems, and HIV risk behaviors in a sample of 167 adolescents, aged 15-19, participating in an independent living preparation program in one midwestern county. Thirty-three percent of the youths identified as white and 67% as youths of color. The sample was almost evenly split by gender (51% male and 49% female). Thirty-five percent of the youths (n = 59) reported some form of sexual abuse; 21 reported unwanted touching, with no unwanted intercourse, and 38 reported unwanted intercourse. Multivariate analyses demonstrated a significant relationship between the severity of sexual abuse and youths' recent HIV risk behaviors, after accounting for the contribution of other childhood trauma and emotional and behavioral problems. The findings support the need for HIV prevention programs targeting sexually abused youths.

Organizational context and provider perception as determinants of mental health service use.

This study refines and tests an individual client model of service use and contrasts it with a model of service provision based on gateway provider perspectives. Structural equation models demonstrate that provider variables account for more service use variation than client variables. The client model accounts for 24% of the variance in service use, while the provider model accounts for 55% of the variance. Youth self-reported mental health was not positively associated with increased services or with provider perception of youth mental health. The provider model demonstrates the critical role played by provider perceptions, which are influenced more by work environment than by client problems.

Youths' access to mental health services: the role of providers' training, resource connectivity, and assessment of need.

This paper posits that providers with training in and knowledge of mental health resources are more likely to recognize youths' mental health problems, and provide youths with services. In 1994 and 1996, we interviewed 792 adolescents who were involved with St. Louis public health, juvenile justice, child welfare. or education service sectors. Two hundred eighty-two youths had received some services, listing 533 providers. We could identify 364 of those providers, and 61% (222) responded concerning service need, service use, and provider knowledge and behavior. Structural equation models demonstrate that provider assessment of youths' mental health problems is the largest and provider knowledge of service resources the second largest determinant of service provision. Youths' self-reported mental health is not positively associated with increased services and is only minimally associated with provider assessment of their problems. Training (both professional and inservice) contributes to higher assessments of youths' problems and greater resource knowledge, which is associated with increased service provision. Providers from the mental health and child welfare sectors have more professional training in mental health and are more likely to receive inservice training. Inservice training should be offered to all who work with youths.

Impact of environment on adolescent mental health and behavior: structural equation modeling.

This study uses structural equation models to describe how objective neighborhood, perceived neighborhood, and environmental support predict mental health; 792 adolescents responded to highly structured interviews. The effect of objective environment on mental health was mediated through its influence on perceived neighborhood. Environmental support mitigated negative perceptions of environment and the effect of perceived environment on mental health, while exposure to violence augmented the negative effect of perceived environment.

HIV prevention for youths in independent living programs: expanding life options.

The incidence of human immunodeficiency virus (HIV) infection among adolescents is increasing. Youths who were abused and neglected and in out-of-home care are among those at highest risk of acquiring HIV. The concurrence of sexual activity and school failures contributes to their high-risk status. Research suggests that changing behaviors of troubled youths requires programs that not only include HIV-related knowledge, attitudes, and skills, but also incentives and skills for educational planning that will expand the future life options of these youths.

Adolescents' and providers' perspectives on the need for and use of mental health services.

PURPOSE: This study examines need for and use of services from both the adolescent's and the service provider's viewpoints. METHODS: The Youth Services Project interviewed 792 youths from the juvenile justice, education, primary health care, and child welfare sectors (200 each); gathered anonymous tallies of the mental health of youthful clients at each sector; and conducted focus groups with providers. RESULTS: A high percentage of youths (12-15%) met DSM-IV criteria for a mental health disorder, yet the sector clients were not identified as having mental health problems. Juvenile justice and child welfare sectors identified the highest percentage of adolescent clients as having mental health problems, and provided the most services (50-80%). The primary health care sector recorded no mental health disorders among the tallied clients, and provided the fewest mental health services (< 20%). Providers' complaints that they lacked knowledge concerning mental health assessment and lacked referral or treatment resources closely paralleled the degree to which their sector underserviced youths. CONCLUSION: Lack of knowledge about the extent of need in adolescents, methods for assessing or treating, and referral resources handicap service providers and explain the gap between need and service.