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Ssewamala FM, McKay MM, Sensoy Bahar O, Nabunya P, Neilands T, Kiyingi J, Namatovu P, Guo S, Nakasujja N, Mwebembezi A. Suubi4StrongerFamilies: A study protocol for a clustered randomized clinical trial addressing child behavioral health by strengthening financial stability and parenting among families in Uganda. Front Psychiatry 2022; 13:949156. [PMID: 36506418 PMCID: PMC9726732 DOI: 10.3389/fpsyt.2022.949156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background Children in Sub-Saharan Africa are burdened by significant unmet mental health needs. Across the region, high rates of poverty, HIV/AIDS, food insecurity, stigma, and an inadequate health safety net system exacerbate serious child behavioral health needs and impede an effective response. Disruptive behavioral disorders are particularly concerning as they persist through adolescence and adulthood. Hence, addressing the context-specific social influences on child behavioral health is critical given that children in the region comprise more than half of the total regional population. Against this backdrop, this study protocol describes a randomized clinical trial that will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial, and context-specific drivers affect the mental health of children in Uganda. Methods The study uses an experimental, longitudinal design across 30 cluster-randomized primary schools to compare single and combination intervention options; influences of economic empowerment and family strengthening on economic, perceptual, and functioning mediators; and context-specific moderators. The study will be conducted with 900 Ugandan children in mid-upper primary school (10-14 years). The three study conditions (n = 300 each) are: (1) economic empowerment only (EE only), (2) multiple family group-based family strengthening only (MFG-based FS only), and (3) combined EE + MFG-based FS. The interventions will be provided for 12 months; and assessments will occur at baseline, 12, 24, and 36 months. Conclusion Children in Sub-Saharan Africa are burdened by significant unmet mental health needs, including disruptive behavior disorders that persist through adolescence and adulthood if left untreated. The proposed study will examine the mechanisms by which economic empowerment and family strengthening interventions targeting social, familial and context-specific drivers affect the mental health of children in mid-upper primary schools in Uganda. Findings from this study can inform group, community, and population approaches that are needed for scalable solutions to address the social drivers negatively impacting child behavioral health in low-resource settings, including in Sub-Saharan Africa. Clinical trial registration [https://clinicaltrials.gov/], identifier [NCT053 68714].
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Affiliation(s)
- Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Mary M. McKay
- Vice Provost Office, Washington University in St. Louis, St. Louis, MO, United States
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Torsten Neilands
- School of Medicine, University of California, San Francisco, San Francisco, LA, United States
| | - Joshua Kiyingi
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Phionah Namatovu
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Shenyang Guo
- Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Manninen M, Koivukangas J, Holm M, Lindgren M. Lifetime psychiatric diagnoses among adolescents with severe conduct problems - A register-based follow-up study. CHILD ABUSE & NEGLECT 2022; 131:105765. [PMID: 35763955 DOI: 10.1016/j.chiabu.2022.105765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 05/26/2022] [Accepted: 06/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Both delinquency and out-of-home care (OOHC) are associated with a wide spectrum of psychiatric disorders. Reform schools (RS) are Finnish OOHC institutions for adolescents with severe conduct problems. OBJECTIVE We investigated the prevalence of psychiatric diagnoses among individuals with a history of RS placement. PARTICIPANTS AND SETTING The data consisted of individuals placed in a RS on the last day of the years 1991, 1996, 2001, 2006 or 2011 (N = 1074) and a matched comparison group (N = 5313). METHODS Information on lifetime psychiatric diagnoses, grouped into eight categories, was collected from the nationwide health care registry. The follow-up time ranged from 17 to 44 years. RESULTS Among RS population, 59.5 % had some psychiatric diagnosis, which was 12-fold compared to general population peers (hazard ratio HR = 12.4). The most prevalent categories were Conduct disorders and/or ADHD (30.7 %, HR = 41.5), Substance use disorders (29.3 %, HR = 16.8,), Other childhood disorders (8.6 %, HR = 11.9) and Personality disorders (10.9 %, HR = 11.6) followed by Mental retardation (6.4 %, HR = 8.4), Schizophrenia spectrum disorders (9.7 %, HR = 7.9), Affective disorders (17.9 %, HR = 7.3), and Disorders of psychological development (6.1 %, HR = 4.4). All differences were statistically significant (p < .001). CONCLUSIONS RS background associates with an excess of psychiatric disorders, which adds to the burden of other known risk factors for adult age well-being. Effective screening and intervention for psychiatric problems should be available both during the RS placement and after-care.
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Affiliation(s)
- Marko Manninen
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Jenny Koivukangas
- Department of Psychology and Logopedics, Faculty of Medicine, Helsinki University, Helsinki, Finland
| | - Minna Holm
- Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden
| | - Maija Lindgren
- Mental Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Asampong E, Ibrahim A, Sensoy-Bahar O, Kumbelim K, Yaro PB, McKay MM, Ssewamala FM. Adaptation and Implementation of the Multiple-Family Group Intervention in Ghana. Psychiatr Serv 2021; 72:571-577. [PMID: 33430647 PMCID: PMC9805812 DOI: 10.1176/appi.ps.201900626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The health system in Ghana is severely underequipped to meet the needs of children with behavioral health problems. A substantial treatment gap exists among individuals with behavioral challenges, necessitating the implementation of an evidence-based intervention to address child behavioral challenges in Ghana. This article presents learning opportunities from the adaptation and initiation process of an evidence-based approach, the multiple-family group (MFG) intervention, aimed at addressing child behavioral challenges in northern Ghana. METHODS The MFG intervention will be tested and implemented in three schools selected through a clustered randomization process, with 60 child-caregiver dyads per school. Each school will be assigned to MFG delivery by parent peers, MFG delivery by School Health Education Program (SHEP) coordinators, or an intervention where students are supplied only with mental health wellness materials and educational supports. The providers will be assessed on a fidelity measure. RESULTS The approach of engaging stakeholders in Ghana is anticipated to prove challenging because multiple partners are involved in MFG implementation. Participants are expected to actively participate, however, given some changes to the protocol to adapt it to the Ghanaian context, including the types of MFG facilitators and sample size. Other anticipated challenges include obtaining permission from key partners such as the education authorities, timing of the study within the academic calendar in Ghana, and meeting the high expectations of school authorities for the study. NEXT STEPS The MFG intervention will be delivered by parent peers and SHEP coordinators at the selected schools.
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Affiliation(s)
- Emmanuel Asampong
- School of Public Health, University of Ghana, Accra (Asampong, Ibrahim); Brown School, Washington University in St. Louis (Sensoy-Bahar, McKay, Ssewamala); BasicNeeds, Tamale, Ghana (Kumbelim, Yaro)
| | - Abdallah Ibrahim
- School of Public Health, University of Ghana, Accra (Asampong, Ibrahim); Brown School, Washington University in St. Louis (Sensoy-Bahar, McKay, Ssewamala); BasicNeeds, Tamale, Ghana (Kumbelim, Yaro)
| | - Ozge Sensoy-Bahar
- School of Public Health, University of Ghana, Accra (Asampong, Ibrahim); Brown School, Washington University in St. Louis (Sensoy-Bahar, McKay, Ssewamala); BasicNeeds, Tamale, Ghana (Kumbelim, Yaro)
| | - Kingsley Kumbelim
- School of Public Health, University of Ghana, Accra (Asampong, Ibrahim); Brown School, Washington University in St. Louis (Sensoy-Bahar, McKay, Ssewamala); BasicNeeds, Tamale, Ghana (Kumbelim, Yaro)
| | - Peter B Yaro
- School of Public Health, University of Ghana, Accra (Asampong, Ibrahim); Brown School, Washington University in St. Louis (Sensoy-Bahar, McKay, Ssewamala); BasicNeeds, Tamale, Ghana (Kumbelim, Yaro)
| | - Mary M McKay
- School of Public Health, University of Ghana, Accra (Asampong, Ibrahim); Brown School, Washington University in St. Louis (Sensoy-Bahar, McKay, Ssewamala); BasicNeeds, Tamale, Ghana (Kumbelim, Yaro)
| | - Fred M Ssewamala
- School of Public Health, University of Ghana, Accra (Asampong, Ibrahim); Brown School, Washington University in St. Louis (Sensoy-Bahar, McKay, Ssewamala); BasicNeeds, Tamale, Ghana (Kumbelim, Yaro)
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McKay MM, Sensoy Bahar O, Ssewamala FM. Implementation science in global health settings: Collaborating with governmental & community partners in Uganda. Psychiatry Res 2020; 283:112585. [PMID: 31590906 PMCID: PMC6954316 DOI: 10.1016/j.psychres.2019.112585] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
Approximately 450 million people, many of whom live in poverty and are from low and middle-income countries (LMICs), experience serious mental health challenges. Children in sub-Saharan Africa comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs and evidence-based practices (EBPs) are scarce. In Uganda, one in five children present mental health challenges, including disruptive behavior disorders. Guided by the Practical, Robust Implementation and Sustainability (PRISM) framework, this paper describes the strategies by which we have engaged community and government partners to invest in a collaborative, longitudinal study in Uganda aimed at improving youth behavioral health outcomes by testing a collaboratively adapted EBP. We emphasize that implementation scientists should be prepared and willing to invest time and effort engaging key stakeholders and sustain relationships through a full range of collaborative activities; ensure that their science meets a felt need among the stakeholders; and translate their research findings rapidly into accessible and actionable policy recommendations. Finally, we highlight that collaboration with global communities and governments plays a critical role in the adaptation, uptake, scalability, and sustainability of EBPs, and that the process of engagement and collaboration can be guided by conceptual frameworks.
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Affiliation(s)
- Mary M McKay
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, United States.
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, United States
| | - Fred M Ssewamala
- Brown School, Washington University in St. Louis, One Brookings Drive, St. Louis, MO, United States
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Taylor M, Kaplan T, Mulvey P, Miller MK. Perceptions of waived juvenile defendants across mental health diagnoses and demographic characteristics. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101474. [PMID: 31706382 DOI: 10.1016/j.ijlp.2019.101474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/10/2019] [Accepted: 07/16/2019] [Indexed: 06/10/2023]
Abstract
Justice involved youth who present with diagnosable mental health issues are commonly prosecuted in criminal courts. Limited research has examined how jurors perceive and respond to transferred juveniles with mental health issues. For the current study, 252 mock jurors were randomly assigned to read one of six profiles (i.e., White male, White female, Black male, Black female, Latino, and Latina) and report culpability, deserved punishment, behavior regulation, and dangerousness for juveniles diagnosed with conduct disorder, major depressive disorder, attention deficit hyperactivity disorder, schizophrenia, and described with antisocial traits/behaviors. A schizophrenia diagnosis was associated with less blame, punishment, and capacity for behavior regulation. A description of antisocial traits/behaviors was associated with more blame, punishment, capacity for behavior regulation, and dangerousness. White juveniles described with antisocial traits were considered more blameworthy and deserving of punishment than Latinos. Considering the temporary nature of adolescent antisocial personality characteristics, jurors should have greater awareness of the maturation process.
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Affiliation(s)
- Melanie Taylor
- 43909 30th St W, Criminal Justice Department, California State University, Bakersfield, Lancaster, CA 93536, United States of America.
| | - Tatyana Kaplan
- 344 Mack Social Science, Mail Stop 1300, Interdisciplinary Social Psychology Ph.D. Program, University of Nevada, Reno, NV 89557, United States of America.
| | - Philip Mulvey
- 411 Schroeder Hall, Department of Criminal Justice Sciences, Illinois State University, Campus Box 5250, Normal, IL 61790-5250, United States of America.
| | - Monica K Miller
- 1664 N. Virginia Mail Stop 214, Criminal Justice Department, University of Nevada, Reno, NV 89557, United States of America.
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Abstract
Justice-involved youth are at exceedingly high risk of trauma exposure, multisystem involvement, and mental health distress, including depression. Justice-involved youth carry with them both a high symptom burden and a high cost to society. Both could be reduced through evidence-based prevention and treatment strategies. Effective treatment of mental disorders may reduce future justice involvement, whereas lack of treatment increases likelihood of justice involvement into adulthood. Multiple effective programs exist to improve the lives of justice-involved youth and subsequently decrease the cost to society of detaining and adjudicating these youth within the juvenile justice system.
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Ruch DA, Sheftall AH, Schlagbaum P, Fontanella CA, Campo JV, Bridge JA. Characteristics and Precipitating Circumstances of Suicide Among Incarcerated Youth. J Am Acad Child Adolesc Psychiatry 2019; 58:514-524.e1. [PMID: 30768395 PMCID: PMC9721273 DOI: 10.1016/j.jaac.2018.07.911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/25/2018] [Accepted: 08/15/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Studies show incarcerated youth are at increased risk for suicidal behavior, yet little is known about factors associated with suicide for this population. Using a nationally representative sample, this study examined characteristics and precipitating circumstances of suicide in incarcerated youth decedents compared with youth suicide decedents in the general population. METHOD Data were analyzed for suicide decedents 10- to 24-years-old (N = 10,126) in the United States from 2003 through 2012 from the National Violent Death Reporting System. Logistic regression compared precipitating circumstances of suicide for incarcerated youth decedents and those not in custody. Details on suicide deaths in detained youth were captured from coroner/medical examiner and law enforcement reports associated with each incident. RESULTS Most youth suicide decedents were older, white, and male regardless of incarceration status. Incarcerated youth suicide decedents were more likely to die by hanging, strangulation, or suffocation and less likely to disclose suicide intent, leave a suicide note, or exhibit depressive symptoms compared with those not in custody. Additional risk factors for suicide were not significantly different between youth decedents in custody and those not in custody, suggesting that unique aspects of the incarceration environment could be associated with an increased risk of suicide. CONCLUSION Study findings highlight the need for early suicide risk detection and developmentally relevant interventions tailored for youth in correctional settings. Future efforts should include evaluation studies to support suicide prevention programs designed for incarcerated youth and research that examines distinctive factors associated with suicidal behavior in youth in custody.
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Affiliation(s)
- Donna A Ruch
- Research Institute at Nationwide Children's Hospital Center for Innovation of Pediatric Practice, Wexner Medical Center, The Ohio State University, Columbus.
| | - Arielle H Sheftall
- Research Institute at Nationwide Children's Hospital Center for Innovation of Pediatric Practice, Wexner Medical Center, The Ohio State University, Columbus
| | - Paige Schlagbaum
- Research Institute at Nationwide Children's Hospital Center for Innovation of Pediatric Practice, Wexner Medical Center, The Ohio State University, Columbus
| | - Cynthia A Fontanella
- Research Institute at Nationwide Children's Hospital Center for Innovation of Pediatric Practice, Wexner Medical Center, The Ohio State University, Columbus
| | - John V Campo
- Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown
| | - Jeffrey A Bridge
- Research Institute at Nationwide Children's Hospital Center for Innovation of Pediatric Practice, Wexner Medical Center, The Ohio State University, Columbus
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Kivumbi A, Byansi W, Damulira C, Namatovu P, Mugisha J, Sensoy Bahar O, McKay MM, Hoagwood K, Ssewamala FM. Prevalence of behavioral disorders and attention deficit/hyperactive disorder among school going children in Southwestern Uganda. BMC Psychiatry 2019; 19:105. [PMID: 30943981 PMCID: PMC6446353 DOI: 10.1186/s12888-019-2069-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 03/03/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Disruptive Behavioral Disorders (DBDs) and Attention Deficit/Hyperactivity Disorder (ADHD) are chronic, impairing, and costly child and adolescent mental health challenges which, when untreated, can result in disruptions in school performance, friendships and family relations. Yet, there is dearth of prevalence data on child and adolescent behavioral challenges within sub-Saharan Africa, including Uganda. This study aims to estimate the prevalence rate of behavioral challenges and ADHD among young school going children and early adolescents (ages 8-13 at study enrollment), utilizing a school-based sample in southwest Uganda. METHODS We present screening results from a 5-year scale-up study titled SMART Africa-Uganda (2016-2021), set across 30 public primary schools located in the greater Masaka region in Uganda, a region heavily impacted by poverty and HIV/AIDS. Specifically, we draw on screening data from caregivers of 2434 children that used well-established standardized measures that had been pre-tested in the region. These were: 1) oppositional defiant disorder (ODD) and conduct disorder (CD) subscales of the Disruptive Behavior Disorders (DBD) scale; and 2) the Iowa Connors and Impairment scales. Slightly over half of the children in the sample were female (52%), with a mean age of 10.27 years. RESULTS Of the 2434 participants screened for disruptive behaviors: 1) 6% (n = 136) scored positive on ODD and 2% (n = 42) scored positive on CD subscales of the DBD scale; 2) 9.61% (n = 234), and 2.67% (n = 65) were reported to have elevated symptoms of ODD and ADHD on the Iowa Connors caregiver report scale respectively. Twenty-five percent (n = 586) of children were described by their caregivers as having experienced some form of impairment in at least four domains of the Impairment scale. CONCLUSION The results indicate the presence of behavioral challenges and ADHD among school going children, aged 8-13 years, in Uganda. Given the negative outcomes associated with behavioral challenges as children transition to adolescence and adulthood, detecting these emerging behavioral challenges early is critical in developing appropriate interventions. School settings could be considered as one of the contextually-relevant, culturally-appropriate, and non-stigmatizing venues to implement screening procedures and to detect emerging behavioral challenges and to make necessary referrals.
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Affiliation(s)
- Apollo Kivumbi
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
| | - William Byansi
- Brown School, Washington University in St. Louis, St. Louis, USA
| | - Christopher Damulira
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
| | - Phionah Namatovu
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
| | | | | | - Mary M. McKay
- Brown School, Washington University in St. Louis, St. Louis, USA
| | | | - Fred M. Ssewamala
- International Center for Child Health and Development, P.O. Box 1988, Circular Rd, Masaka, Uganda
- Brown School, Washington University in St. Louis, St. Louis, USA
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Ssewamala FM, Sensoy Bahar O, McKay MM, Hoagwood K, Huang KY, Pringle B. Strengthening mental health and research training in Sub-Saharan Africa (SMART Africa): Uganda study protocol. Trials 2018; 19:423. [PMID: 30081967 PMCID: PMC6080393 DOI: 10.1186/s13063-018-2751-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children in Sub-Saharan Africa (SSA) comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs. Although effective interventions for the treatment of disruptive behavioral disorders (DBDs) in youth have been tested in high-poverty and high-stress communities in developed countries, and are relevant for widespread dissemination in low- and middle-income countries (LMICs), most of these evidence-based practices (EBPs) have not been utilized in SSA, a region heavily impacted by poverty, diseases including HIV/AIDS, and violence. Thus, this paper presents a protocol for a scale-up longitudinal experimental study that uses a mixed-methods, hybrid type II, effectiveness implementation design to test the effectiveness of an EBP, called Multiple Family Group (MFG) aimed at improving child behavioral challenges in Uganda while concurrently examining the multi-level factors that influence uptake, implementation, sustainment, and youth outcomes. METHODS The MFG intervention will be implemented and tested via a longitudinal experimental study conducted across 30 public primary schools located in both semi-urban and rural communities. The schools will be randomly assigned to three study conditions (n = 10 per study condition): (1) MFG delivered by trained family peers; (2) MFG delivered by community health workers; or; (3) comparison: usual care comprising mental health care support materials, bolstered with school support materials. A total of 3000 children (ages 8 to 13 years; grades 2 to 7) and their caregivers (N = 3000 dyads); 60 parent peers, and 60 community health workers will be recruited. Each study condition will comprise of 1000 child-caregiver dyads. Data will be collected at baseline, 8 and 16 weeks, and 6-month follow-up. DISCUSSION This project is the first to test the effectiveness of the MFG intervention while concurrently examining multi-level factors that influence overall implementation of a family-based intervention provided in schools and aimed at reaching the large child population with mental health service needs in Uganda. Moreover, the study draws upon an EBP that has already been tested for delivery by parent peers and community facilitators, and hence will take advantage of the advancing science behind task-shifting. If successful, the project has great potential to address global child mental health needs. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03081195 . Registered on 16 March 2017.
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Affiliation(s)
- Fred M. Ssewamala
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO 63130 USA
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, School of Medicine, New York University, 550 First Avenue, New York, NY 10016 USA
| | - Keng-Yen Huang
- Department of Child and Adolescent Psychiatry, School of Medicine, New York University, 550 First Avenue, New York, NY 10016 USA
| | - Beverly Pringle
- National Institute of Mental Health, 6001 Executive Boulevard, Bethesda, MD 20892 USA
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Gaete J, Labbé N, Del Villar P, Allende C, Araya R, Valenzuela E. Mental health and associated factors among young offenders in Chile: a cross-sectional study. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:13-27. [PMID: 28402002 DOI: 10.1002/cbm.2029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 09/15/2016] [Accepted: 12/20/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND Few studies in Latin America have explored mental disorder among young offenders, or variables associated with it. AIMS Our aim was to test for associations between childhood adversity or substance misuse and psychiatric disorders among young offenders. METHODS Sentenced adolescent offenders were recruited from young offenders' institutions or community centres provided by the Chilean National Service for Minors. Psychiatric disorders were assessed using the Mini International Neuropsychiatric Interview, conducted by trained psychologists. A trained sociologist used an ad hoc interview to collect information about childhood experiences, including parenting, trauma, education and substance misuse. Multivariable logistic regressions were used to analyse data. RESULTS The most prevalent psychiatric disorders among the 935 participants were marijuana dependence disorder, major depressive disorder, and anxiety disorders. Substance use disorders were less frequent among young offenders who were serving their sentence in young offenders' institutions than among those serving in community centres and more frequent among those who started to use marijuana at an earlier age. Among other variables, childhood maltreatment was related to major depressive disorder, and maternal death to anxiety disorders. Higher educational status was related to a lower frequency of depressive and anxiety disorders. CONCLUSIONS Our findings suggest that greater efforts must be made to identify vulnerable young people much earlier. Few of these young offenders with mental health problems had been well adjusted in health, education or socially before this period of detention. © 2017 The Authors. Criminal Behaviour and Mental Health Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Jorge Gaete
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Department of Public Health and Epidemiology, Faculty of Medicine, Universidad de los Andes, Monseñor Álvaro del Portillo, 12455, Santiago, Chile
| | - Nicolas Labbé
- School of Psychology, University of Los Andes, Santiago, Chile
| | - Paloma Del Villar
- Institute of Sociology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Catalina Allende
- Institute of Sociology, Pontifical Catholic University of Chile, Santiago, Chile
| | - Ricardo Araya
- Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Eduardo Valenzuela
- Institute of Sociology, Pontifical Catholic University of Chile, Santiago, Chile
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Hettiarachchi LV, Kinner SA, Tibble H, Borschmann R. Self-Harm among Young People Detained in the Youth Justice System in Sri Lanka. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E209. [PMID: 29373512 PMCID: PMC5858278 DOI: 10.3390/ijerph15020209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/03/2022]
Abstract
Self-harm is prevalent in incarcerated adults, yet comparatively few studies of self-harm in detained youth (and even fewer in low- and middle-income countries) have been published. We examined the prevalence and correlates of self-harm in a sample of 181 young people (mean age 15.0 years, SD = 2.3) detained in the youth justice system in Sri Lanka. Structured face-to-face questionnaires assessed demographic characteristics, family and social background, substance use, self-harm history (including frequency, method, and intention), bullying victimization, physical and sexual abuse (victimization and perpetration), and exposure to self-harm/suicide by others. Seventy-seven participants (43%) reported a lifetime history of self-harm, 19 of whom (25%) who reported doing so with suicidal intent. Fifty participants (65% of those with a history of self-harm) reported engaging in self-harm impulsively, with no prior planning. A history of self-harm was associated with being female, prior sexual abuse victimization, prior exposure to self-harm by friends, and a lifetime history of self-harm ideation. High rates of substance use, bullying victimization, parental incarceration, and exposure to suicide were reported across the sample. Young people detained in the youth justice system in Sri Lanka are a vulnerable group with high rates of self-harm, substance use, and psychosocial risk factors. Strategies for identifying and preventing self-harm, and targeted psychological interventions designed specifically to address impulsivity, may contribute to more positive outcomes in this marginalised population.
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Affiliation(s)
- Lushan V Hettiarachchi
- Forensic Psychiatric Unit, National Institute of Mental Health, Colombo 10620, Sri Lanka.
| | - Stuart A Kinner
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne 3052, Australia.
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
- Mater Research Institute-UQ, University of Queensland, Brisbane 4072, Australia.
- Griffith Criminology Institute, Griffith University, Brisbane 4111, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne 3800, Australia.
| | - Holly Tibble
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
| | - Rohan Borschmann
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne 3052, Australia.
- Centre for Mental Health, Melbourne School of Population of Global Health, University of Melbourne, Melbourne 3010, Australia.
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE58AF, UK.
- Department of Psychiatry, University of Melbourne, Melbourne 3010, Australia.
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12
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Bowser D, Henry BF, Wasserman GA, Knight D, Gardner S, Krupka K, Grossi B, Cawood M, Wiley T, Robertson A. Comparison of the Overlap between Juvenile Justice Processing and Behavioral Health Screening, Assessment and Referral. JOURNAL OF APPLIED JUVENILE JUSTICE SERVICES 2018; 2018:97-125. [PMID: 30680311 PMCID: PMC6342497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Given the large proportion of youth involved in the juvenile justice system who meet criteria for behavioral health disorders, the system is charged with delivering not only criminal justice programing, but also behavioral health services. Behavioral health service delivery is typically done through collaborative partnerships with behavioral health agencies. This study created process maps which describe the flows and boundaries of these partnerships with respect to screening, assessment and referral to treatment. Process maps of juvenile justice and behavioral health systems from six juvenile departments in different states (Mississippi, Kentucky, New York, Georgia, Texas, and Pennsylvania) are presented. Both the methodology of creating process maps and results from the analysis of the maps are presented. Results indicate that behavioral health screening, assessment, and referral to treatment were occurring at all sites, typically with standardized tools. Overall trends were that juveniles tended to have more screenings, assessments, and referrals to behavioral health services as they moved deeper into the juvenile justice system and were placed into more formal juvenile justice services. Within the analysis of interagency communication, these results were mirrored; settings that were more formal and located deeper into the juvenile justice system had more robust interagency communication.
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Affiliation(s)
- Diana Bowser
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA 02453
| | - Brandy F Henry
- Brandeis University, Heller School for Social Policy and Management, Waltham, MA 02453
| | | | - Danica Knight
- Texas Christian University, Institute of Behavioral Research, Fort Worth, TX 76129
| | - Sheena Gardner
- Mississippi State University, Social Science Research Center, Starkville, MS 39762
| | - Kate Krupka
- Columbia University, Department of Psychiatry, NY, NY 10032
| | | | | | | | - Angela Robertson
- Mississippi State University, Social Science Research Center, Starkville, MS 39762
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13
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14
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Acri MC, Bornheimer LA, O’Brien K, Sezer S, Little V, Cleek AF, McKay MM. A model of integrated health care in a poverty-impacted community in New York City: Importance of early detection and addressing potential barriers to intervention implementation. SOCIAL WORK IN HEALTH CARE 2016; 55:314-27. [PMID: 27070372 PMCID: PMC5545980 DOI: 10.1080/00981389.2015.1137256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention.
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Affiliation(s)
- Mary C. Acri
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
| | - Lindsay A. Bornheimer
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
| | - Kyle O’Brien
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
| | - Sara Sezer
- The Institute for Family Health, New York, New York, USA
| | - Virna Little
- The Institute for Family Health, New York, New York, USA
| | - Andrew F. Cleek
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
| | - Mary M. McKay
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
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15
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Mansion AD, Chassin L. The Effect of Race/Ethnicity on the Relation between Substance Use Disorder Diagnosis and Substance Use Treatment Receipt among Male Serious Adolescent Offenders. CHILDREN AND YOUTH SERVICES REVIEW 2016; 61:237-244. [PMID: 26806995 PMCID: PMC4721274 DOI: 10.1016/j.childyouth.2015.12.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The high rates of substance disorders in the juvenile justice system, as well as the relation between substance use and reoffending, suggest the importance of substance use treatment service and understanding the factors that influence treatment provision. The current study tested whether race/ethnicity affects the relation between substance use disorder diagnosis and the receipt of substance use treatment services among a sample of male serious juvenile offenders (N=638). Findings showed that among adolescents with a substance use disorder diagnosis, there were no race/ethnicity differences in substance use treatment receipt. However, among adolescents without a substance use disorder diagnosis, non-Hispanic Caucasians were more likely to receive substance use treatment than were Hispanics or African-Americans. Additionally, findings showed that there were race/ethnicity differences in service receipt at moderate levels of substance use problems, such that non-Hispanic Caucasians were more likely to receive substance use treatment than Hispanics or African-Americans. There were no race/ethnicity differences in treatment receipt when substance use problems were either very severe or very low. Results suggest that race/ethnicity may play a role in service provision in the juvenile justice system when levels of need are less clear.
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Affiliation(s)
- Andre D. Mansion
- Arizona State University Psychology Department and Sandra Day O’Connor College of Law, USA
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16
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Abstract
There is a large proportion of minority youth involved in the juvenile justice system. Disproportionate minority contact (DMC) occurs when the proportion of any ethnic group is higher at any given stage in the juvenile justice process than the proportion of this group in the general population. There are several theories explaining the presence and persistence of DMC. This article reviews the history of DMC and the theories and implications of this problem. It discusses several targets for interventions designed to reduce DMC and offer resources in this area.
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17
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Mallett CA, Kirven J. Comorbid Adolescent Difficulties: Social Work Prevention of Delinquency and Serious Youthful Offending. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2015; 12:509-23. [PMID: 25844994 DOI: 10.1080/15433714.2014.942020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A majority of adolescents who are formally involved with the juvenile courts and detained or incarcerated are dealing with past or present maltreatment victimization, learning disabilities, and/or mental health/substance abuse difficulties. Addressing these problems and traumas is an integral part of preventing delinquency and breaking a youthful offender's recidivist cycle, a pattern that often predicts adult offending and incarceration. Fortunately, there are effective programs across the social work profession that decrease or may even eliminate delinquent behaviors, both for low-level and more serious youthful offenders. Unfortunately, the use of these social work preventative programs is not consistent or extensive within the juvenile justice system.
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El Bcheraoui C, Zhang X, Welty LJ, Abram KM, Teplin LA, Sutton MY. HIV Knowledge Among a Longitudinal Cohort of Juvenile Detainees in an Urban Setting. JOURNAL OF CORRECTIONAL HEALTH CARE 2015; 21:112-24. [PMID: 25788607 PMCID: PMC5704944 DOI: 10.1177/1078345815572596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors investigated HIV knowledge change among a cohort of juvenile detainees. Participants completed an HIV knowledge survey at baseline and up to 4 more times over 6 years. The authors calculated knowledge scores; the time serial trend of scores was modeled using generalized estimating equations. A baseline survey was completed by 798 participants, ages 14 to 18 years; mean HIV knowledge scores ranged from 11.4 to 14.1 (maximum score = 18). Males had significantly lower HIV knowledge scores than females at baseline only. Over time, Hispanic participants had significantly lower scores than non-Hispanic Black and non-Hispanic White participants. Overall, HIV knowledge increased but was still suboptimal 5 years after baseline. These findings suggest the need to develop and strengthen HIV prevention education programs in youth detention settings.
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Affiliation(s)
- Charbel El Bcheraoui
- Epidemic Intelligence Service, Division of Applied Sciences, Scientific Education and Professional Development Program, Office of Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Xinjian Zhang
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Leah J Welty
- The Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA The Feinberg School of Medicine, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Karen M Abram
- The Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Linda A Teplin
- The Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Madeline Y Sutton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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19
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Elkington KS, Teplin LA, Abram KM, Jakubowski JA, Dulcan MK, Welty LJ. Psychiatric disorders and violence: a study of delinquent youth after detention. J Am Acad Child Adolesc Psychiatry 2015; 54:302-12.e5. [PMID: 25791147 PMCID: PMC4369770 DOI: 10.1016/j.jaac.2015.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 12/18/2014] [Accepted: 01/08/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To examine the relationship between psychiatric disorders and violence in delinquent youth after detention. METHOD The Northwestern Juvenile Project is a longitudinal study of youth from the Cook County Juvenile Temporary Detention Center (Chicago, Illinois). Violence and psychiatric disorders were assessed via self-report in 1,659 youth (56% African American, 28% Hispanic, 36% female, aged 13-25 years) interviewed up to 4 times between 3 and 5 years after detention. Using generalized estimating equations and logistic regression, we examined the following: the prevalence of violence 3 and 5 years after detention; the contemporaneous relationships between psychiatric disorders and violence as youth age; and whether the presence of a psychiatric disorder predicts subsequent violence. RESULTS Rates of any violence decreased between 3 and 5 years after detention, from 35% to 21% (males), and from 20% to 17% (females). There was a contemporaneous relationship between disorder and violence. Compared to the group with no disorder, males and females with any disorder had greater odds of any violence (adjusted odds ratio [AOR] = 3.0, 95% CI = 1.9-4.7, and AOR = 4.4, 95% CI = 3.0-6.3, respectively). All specific disorders were associated contemporaneously with violence, except for major depressive disorder/dysthymia among males. Substance use disorders predicted subsequent violence. Males with other drug use disorder and females with marijuana use disorder 3 years after detention had greater odds of any violence 2 years later (AOR = 3.4, 95% CI = 1.4-8.2, and AOR = 2.0, 95% CI = 1.1-3.8, respectively). CONCLUSION Aside from substance use disorders, the psychiatric disorders studied may not be useful markers of subsequent violence. Violence assessment and reduction must be key components of ongoing psychiatric services for high-risk youth.
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Affiliation(s)
- Katherine S Elkington
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, and Columbia University, New York
| | - Linda A Teplin
- Northwestern University, Feinberg School of Medicine, Chicago.
| | - Karen M Abram
- Northwestern University, Feinberg School of Medicine, Chicago
| | | | - Mina K Dulcan
- Northwestern University, Feinberg School of Medicine, Chicago; Ann and Robert H. Lurie Children's Hospital of Chicago
| | - Leah J Welty
- Northwestern University, Feinberg School of Medicine, Chicago
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Abstract
Each year 200,000 youth under the age of 18 are waived to adult criminal court, and African American males are disproportionately overrepresented among youth detained in adult jails. This population of vulnerable youth may be at greater risk for early violent death and HIV infection than youth detained in juvenile settings. The purpose of this study was to examine the social context of HIV risk behavior, substance misuse, and violence among youth offenders detained in adult jail using Elijah Anderson’s Code of the Street as a conceptual framework. Focus groups were conducted with 15 African American male youth (aged 15-17 years) detained at a city jail. Content analysis revealed several themes related to violence and HIV risk, including (1) HIV literacy and condom use, (2) substance use and sex, and (3) violence and the code of the street. These rich, descriptive narratives suggest that youth offenders exposed to chronic violence also engage in HIV risk–related behaviors. Findings may also aid in the development of age- and culturally appropriate interventions for this population while they are detained.
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21
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Godette DC, Mulatu MS, Leonard KJ, Randolph S, Williams N. Racial/ethnic disparities in patterns and determinants of criminal justice involvement among youth in substance abuse treatment programs. JOURNAL OF CORRECTIONAL HEALTH CARE 2011; 17:294-308. [PMID: 21821605 DOI: 10.1177/1078345811413084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescent substance abuse is a criminal behavior; however, not all criminal behaviors result in criminal justice involvement. This study examined disparities among adolescents aged 12 to 17 admitted to substance abuse treatment nationwide. Findings indicate significant disparities in patterns and determinants of criminal justice involvement between White and minority adolescents. Minorities were significantly more likely to be involved with the criminal justice system, even after controlling for criminal behaviors, substance abuse, mental health problems, and socioenvironmental risk. Findings reveal that connections to the educational system may be especially important for minority groups. The importance of developing systems of treatment for adolescents in the community and correctional system that are part of the same continuum of care is highlighted.
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Affiliation(s)
- Dionne C Godette
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, USA.
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22
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Fast DK, Conry J. Fetal alcohol spectrum disorders and the criminal justice system. ACTA ACUST UNITED AC 2009; 15:250-7. [DOI: 10.1002/ddrr.66] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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