Kenneth M. Rogers

Mental Health and Incarcerated Youth. II: Service Utilization

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program (n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities (n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarcenation may benefit from intensive mental health services to prevent out-of-home placement and later incarceration.

Who Is Referred to Mental Health Services in the Juvenile Justice System

We describe the mental health referral rate among youth in a correction facility, examine how sociodemographic and criminal history characteristics relate to referral, and explore how these variables and diagnostic class differ by referral source. Data were abstracted from case records. The referral rate was low (6%). Non-Latino youth, repeat offenders, and violent offenders were more likely to be referred compared to all detained youth. Referral source also varied by violent offense history and diagnosis type. Future studies examining access to mental health services should take into account a detained youths sociodemographic, criminal history, and clinical characteristics.

The Impact of Mental Health Services in a Pediatric Emergency Department: The Implications of Having Trained Psychiatric Professionals.

Objectives This study assessed improvement in the emergency department (ED) length of stay and costs after implementation of an ED program which added board-certified psychiatrists and trained psychiatric social workers to the pediatric ED. Methods A retrospective medical record and administrative data review were conducted for all pediatric psychiatric visits of children aged 5 to 18 years who were seen and discharged from the Greenville Memorial Hospital ED between January 1, 2007, and June 31, 2013. These subjects were diagnosed by the ED physician at the time of the visit using codes ranging from 290.0 to 319.0 based on the International Statistical Classification of Diseases and Related Health Problems, Ninth Revision codes. Results The mean (SD) age of children in the postprogram period (14.3 ± 3.1) was younger than during the preprogram period (14.9 ± 3.1) (P < 0.001) with the greatest increase in the 11- to 15-year age group (42% vs 35%, respectively). Patients in the postprogram period were significantly more likely to be discharged to a psychiatric hospital than during the pre-program period (18% vs 9%, respectively). After the initiation of the program, ED length of stay decreased significantly from 14.7 to 12.1 hours (P < 0.001) and costs per visit decreased slightly from US

Suicide Among African-American and Other African-Origin Youth

602 to US

Inpatient Psychiatric Hospitalization

588 (this difference was not statistically significant). Conclusions Although this model of care has significant costs associated with it, the efficiency of care for psychiatric pediatric patients in the ED improved after targeted training of ED staff and provision of these specialized services within the ED.

EXPLANATORY MODELS OF ADHD: DO THEY DIFFER BY ETHNICITY, CHILD GENDER, OR TREATMENT STATUS?

Children and youth in the United States descended from African ancestry are a heterogeneous group that may self-identify as Black or African-American. Those who have immigrated to the United States are primarily of African or Caribbean origin. While this group is socioeconomically diverse as well, the existing literature has focused on urban poor youth, who are often at higher risk for sociocultural stressors such as community violence. Historically, Black youth have had lower rates of suicide, but this dramatically increased in the 1980s and 1990s, despite a decrease in European-American youth. It is currently the third leading cause of death for Black youth ages 15–24. Unique risk factors include the impact of discrimination and acculturative stress. This chapter will review the literature regarding risk and protective factors as well as interventions in this population. A case will be presented to illustrate the concepts.

Cultural Competence in Child Psychiatric Practice

Inpatient hospitalization among African American youth has come under heightened scrutiny in recent years because of increased cost, the restrictive nature of the treatment, and the fact that hospitalized youth are at greater risk of rehospitalization within a few weeks of discharge. Furthermore, evidence suggests that African American and other minority youth are more frequently psychiatrically hospitalized rather than receive other less restrictive evidence-based treatments. Because aggression and impulsivity are the two primary reasons for presentation to emergency and inpatient psychiatric services, many clinical issues are overshadowed by the prominence of these externalizing symptoms. There are individual and societal factors that contribute to the overutilization of inpatient treatment including underutilization of outpatient services. Stigma and access are additional key factors. Many African American youth grow up in neighborhoods where there is a paucity of mental health services. Although there is increased insurance coverage through the Affordable Care Act and the Children’s Health Insurance Program, there remains a deficiency of available providers in numerous localities that continues to restrict accessibility to care. This dearth of available services contributes to youth not receiving appropriate interventions, but also likely adds to the overutilization of hospitalization to the exclusion of other more effective and targeted treatments. Identification of African American youth with mental health issues is a challenge and, when identified, many youth receive diagnoses that are incorrect leading to treatment decisions that may not be in their best interest. Cultural incompetence has been acknowledged as a barrier to effective care. Research over the past 20 years chronicles the problems of incorrect diagnosis, overuse of antipsychotic medication, and how treatment is received in more restrictive placements. The use of evidence-based and culturally competent outpatient care will help us to correct this overutilization while making treatment recommendations that are more acceptable to this patient population.