Positive family relationships and religious affiliation as mediators between negative environment and illicit drug symptoms in American Indian adolescents.

The present study tests how positive family relationships and religious affiliation mediate between negative familial and social environments, and adolescent illicit drug abuse/dependence symptoms. The theoretical framework is based on an integration of two theories: the ecological model of human development (Bronfenbrenner, 1979) and the social development model (Hawkins & Weis, 1985). We used a stratified random sample of 401 American Indian adolescents. A path analysis tested the integrative theoretical model. Findings showed that positive family relationships mediated the negative impact of addicted family members, violence victimization, and negative school environment on illicit drug abuse/dependence symptoms. Religious affiliation mediated the negative effect of deviant peers on positive family relationships. Intervention and prevention efforts may benefit from promoting positive family relationships and religious affiliation to reduce the impact of complex familial and social problems on illicit drug symptoms.

Child Welfare Workers' Connectivity to Resources and Youth's Receipt of Services.

Youth involved in the child welfare system are at high risk for mental illness, substance abuse, and other behavioral health issues, which child welfare workers are expected to address through referrals. Child welfare workers (N=27) who participated in Project IMPROVE (Intervention for Multisector Provider Enhancement) reported on services they provided to youth (N=307) in their caseloads. Using survey and administrative data, this paper examines workers' service actions on behalf of youth. Results were consistent with the Gateway Provider Model and showed that youth received help from a greater variety of service sectors when their workers were able to identify behavioral health problems, and were familiar with and connected to other providers in the community. Improving service delivery to youth in child welfare may be accomplished by training workers in the signs and symptoms of behavioral health problems and familiarizing them with providers in the community.

Reflections on a proposed theory of reservation-dwelling American Indian alcohol use: comment on Spillane and Smith (2007).

In their recent article, N. Spillane and G. Smith suggested that reservation-dwelling American Indians have higher rates of problem drinking than do either non-American Indians or those American Indians living in nonreservation settings. These authors further argued that problematic alcohol use patterns in reservation communities are due to the lack of contingencies between drinking and "standard life reinforcers" (SLRs), such as employment, housing, education, and health care. This comment presents evidence that these arguments were based on a partial review of the literature. Weaknesses in the application of SLR constructs to American Indian reservation communities are identified as is the need for culturally contextualized empirical evidence supporting this theory and its application. Cautionary notes are offered about the development of literature reviews, theoretical frameworks, and policy recommendations for American Indian communities.

Child Welfare Workers' Adoption of Decision Support Technology.

Child welfare workers must process complex information in deciding to refer clients to appropriate mental health services. Decision support systems (DSS) have been demonstrated in other fields to be an important tool, yet little research has been done in child welfare. This study focused on the adoption of a specific DSS into child welfare practice. Quantitative analysis was used to demonstrate the diffusion of innovation process among a sample of state child welfare workers, while qualitative analysis was used to explain the facilitators and barriers to DSS adoption. Results indicate that for DSSs to be widely adopted in child welfare practice, they should be integrated into the referral system and include workers' knowledge and experiences with referral resources. For successful adoption, DSSs need to respect the natural logic and flow of worker interaction, as well as organizational constraints.

From early to late adolescence: American Indian youths' behavioral trajectories and their major influences.

OBJECTIVE: This article identifies behavioral trajectories of American Indian adolescents and examines their predictors. METHOD: A total of 401 urban and reservation American Indian adolescents were interviewed yearly from 2001 to 2004 (with 341 youths, or 85%, retained to 2004, and 385 completing at least two interviews). The Youth Self-Report total problem score is used to model behavior change trajectories, with psychological (addictions and mental health) and environmental (family, peer, community, and services) variables as independent variables. Analyses were based on PROC TRAJ, an SAS macro. RESULTS: Five trajectory groups were found. Youths who started with a Youth Self-Report score less than the clinical cutoff were low stable (n = 142) or low improving (n = 175). Youths with initial scores over the cutoff were very high chronic (n = 5), high improving (n = 30), or high chronic (n = 33). High improvers scored close to the low improving group by 2004. At baseline, the high improving group was more likely than the high chronic group to be from the reservation (odds ratio 5.94), have greater family satisfaction (1.14), and have fewer school problems (0.84). Over time, the high improving group had substance use and depression drop, family satisfaction increase, fewer parents with mental health or addictions problems, fewer peers using substances, and a decrease in neighborhood problems and stressors. CONCLUSIONS: A significant majority (more than 82%) of the youths exhibited relatively low levels of problem behaviors over all 4 years, and 42% of those with clinically significant problems improved over time.

Culture and environment as predictors of alcohol abuse/dependence symptoms in American Indian youths.

This study utilizes Bronfenbrenner's ecological model (1979) to examine multiple and interactive environmental (familial, social, and cultural) predictors of adolescent alcohol abuse/dependence symptoms. A stratified random sample of 401 American Indian youths was interviewed in 2001. The findings showed that family members' substance problems, peer misbehaviors, and participation in generic cultural activities positively predicted adolescent alcohol symptoms. Conversely, cultural pride/spirituality predicted fewer alcohol symptoms, and, importantly, religious affiliation moderated the effects of problematic peers and family members on adolescent alcohol symptoms. The findings suggest further study of intervention and prevention efforts regarding the benefits from consideration of the complex relationships among multiple environmental variables.

The role of providers in mental health services offered to American-Indian youths.

OBJECTIVE: American-Indian adolescents have high rates of addiction and mental health problems but low rates of service use. The gap between service need and use appears to be even larger than the known gap for the general population, and few of the services are provided by specialists. This study examined receipt of treatment by American-Indian youths for addictions or mental health problems, the service provider who first identified a problem and sent a youth to treatment, and the extent to which the provider's knowledge and assessment predicted variance in service actions. METHODS: A sample of 401 American-Indian youths (196 from an urban area and 205 from a reservation) aged 12 to 19 years was first interviewed in person in 2001. A total of 188 of the youths' treatment providers were then interviewed. RESULTS: Structural equation modeling showed that 30 percent of the variance in addictions or mental health services provided to youths was predicted by the provider's assessment of the youth's mental health, the provider's resource knowledge, and provider type. CONCLUSIONS: The results demonstrate that professional, informal, and traditional providers play a pivotal role in providing treatment services offered to American-Indian youths and that these providers were more likely to identify a youth's problems and to offer and refer services when the provider knew more about community resources for the youth and about the youth's personal and environmental problems.

Factors associated with successful functioning in American Indian youths.

This study examines environmental and cultural factors related to successful functioning in a stratified random sample of 401 American Indian youths. The success index included seven indicators: good mental health, being alcohol- and drug-free, absence of serious misbehavior, clean police record, good grades, positive psychosocial functioning, and positive behavior and emotions. Family satisfaction was positively related to overall successful functioning, whereas misbehaving peers, living in a dysfunctional neighborhood, and experiencing child abuse had an inverse relationship with success.

HIV/AIDS protective factors among urban American Indian youths.

This research examined how family and individual factors influence 3 HIV/AIDS risk behaviors: having more than 1 sexual partner in the last 3 months, substance use at last sexual intercourse, and condom non-use at last sexual intercourse. The sample includes 89 sexually active American Indian adolescents living in a large Southwestern U.S. city. Logistic regression results revealed that family communication acts as a protective factor against HIV risk through a lower reported substance use during last sexual intercourse, but it did not appear to affect the number of multiple recent sex partners. Family and personal involvement in American Indian cultural activities, both low on average in this urban sample, had no effect on outcomes. This study advances knowledge on sexual health risk and protective factors among American Indian adolescents, an understudied group, and provides implications for prevention intervention with American Indian youths and their families.

Cultural and ethical issues concerning research on American Indian youth.

A study of American Indian youths illustrates competing pressures between research and ethics. A stakeholder-researcher team developed three plans to protect participants. The first allowed participants to skip potentially upsetting interview sections. The second called for participants to skip potentially upsetting interview sections. The second called for participants flagged for abuse or suicidality to receive referrals, emergency 24-hr clinical backup, or both. The third, based on the community's desire to promote service access, included giving participants a list of service resources. Interviewers gave referrals to participants flagged as having mild problems, and reported participants with serious problems to supervisors for clinical backup. Participants seldom chose to skip sections, so data integrity was not compromised. However, participants did have more problems than expected (e.g., 1 in 3 had thought about suicide, 1 in 5 had attempted suicide, and 1 in 4 reported abuse), so service agencies were not equipped to respond. Researchers must accept the competing pressures and find ethically appropriate compromises that will not undermine research integrity.

Field research with underserved minorities: the ideal and the real.

The realities of doing field research with high-risk, minority, or indigenous populations may be quite different than the guidelines presented in research training. There are overlapping and competing demands created by cultural and research imperatives. A National Institute on Drug Abuse (NIDA)-funded study of American Indian youth illustrates competing pressures between research objectives and cultural sensitivity. This account of the problems that were confronted and the attempts made to resolve them will hopefully fill a needed gap in the research literature and serve as a thought-provoking example for other researchers. This study built cross-cultural bridges. Researchers worked as a team with stakeholders to modify the instruments and methods to achieve cultural appropriateness. The researchers agreed to the communities' demands for increased service access and rights of refusal for all publications and presentations. Data indicate that these compromises did not substantially harm the first year of data collection completeness or the well-being of the youth. To the contrary, it enhanced the ability to disseminate results to those community leaders with the most vested interests. The conflicts between ideal research requirements and cultural demands confronted by the researchers and interviewers in the American Indian community were not necessarily different from issues faced by researchers in other communities. Of major import is the recognition that there are no easy answers to such issues within research.

Factors affecting American Indian adolescent tobacco use.

The present study merged problem behavior and social ecological theories to examine how mental health and environmental factors, including culture, were associated with American Indian youth tobacco use. A stratified random sample of 205 reservation and 196 urban American Indian adolescents living in a Southwestern area was interviewed in 2001. Two-thirds of the reservation youth and half of the urban youth in this sample reported lifetime tobacco use. Logistic regression showed that, when controlling for age and location, a mental health factor (substance abuse/dependence) and environmental factors (e.g., family members' mental health problems and peer misbehavior) were significant predictors of American Indian adolescent tobacco use. Cultural factors and location (reservation vs. urban) were not significant predictors of their tobacco use. Therefore, environmental and mental health factors should be assessed for and incorporated into tobacco use intervention and prevention plans for American Indian youth in both reservation and urban areas.

Building a model to understand youth service access: the gateway provider model.

Enhancing the functioning of parents, teachers, juvenile justice authorities, and other health and mental heal professionals who direct children and adolescents to services is a major mental health services concern. The Gateway Provider Model is an elaborated testable subset of the Network-Episode Model (NEM; B. A. Pescosolido & C. A. Boyer, 1999) that synthesizes it with Decision (D. H. Gustafson, et al., 1999) and organizational theory (C. Glisson, 2002; C. Glisson & L. James, 1992, 2002). The Gateway Provider Model focuses on central influences that affect youth's access to treatment, i.e., the individual who first identifies a problem and sends a youth to treatment (the "gateway provider"); and the need those individuals have for information on youth problems and relevant potential resources. Preliminary studies by the authors and other applicable studies (D. Carise & O. Gurel, 2003) show that providers' perception of need, and their knowledge of resources, and their environment are related to the decision to offer or refer to services, supporting key aspects of the Model.

Suicidal behavior in urban American Indian adolescents: a comparison with reservation youth in a southwestern state.

The majority of American Indians live off of reservations, yet research on suicidal behavior in this population overwhelmingly focuses on reservation Indians. This exploratory study interviewed a stratified random sample of 144 urban and 170 reservation American Indian adolescents to compare rates and correlates of suicidal behavior. One fifth of urban youth and one third of reservation youth reported lifetime suicidal ideation, although similar numbers (14%-18%) reported an attempt. Urban youth had fewer psychosocial problems, and in separate multivariate analyses, the groups shared no common correlate of attempted suicide. Different approaches to prevention and treatment may be warranted for urban Indian youth.

Functioning mediates between symptoms and provider assessment.

The gap between service need and service use for youth with behavioral health problems is well documented. Although provider perception of need predicts service access, studies have found low associations between youth report and provider perception. This paper posits that provider perception of functioning mediates the relationship between youth need as measured by symptoms and provider assessment of that need. Interviews concerning service need and use with 792 14-18-year olds, and surveys of 222 of their providers, were analyzed through structural equation models. Functioning mediated the path from symptoms to assessment when contextual variables were not included in the model, but did not explain additional service use. However, when both contextual factors and functioning were included, the path from functioning to assessment was not significant and less service variance was explained (46% vs. 55%) than in a model not including functioning. Functioning may explain the relationship between symptoms and assessment, but organizational and individual provider variables explain service variance.

A multivariate risk model for childhood behavior problems.

In a study of 306 children whose parents have a mental illness, the relationship between coping skills and environmental assets and deficits determined the degree of behavior problems among these high-risk children. Two environmental stressors (proportion of mentally ill family members and mother-child discord), two coping skills (activity competence and school competence), and an interaction (between proportion of mentally ill family members and activity competence) were found to explain 40% of the variance in child behavior problems.