Extending Mental Health Care as a Strategy to Reduce DMC

1. Extending Mental Health Care as a Strategy to Reduce DMC Salome Raheim, Ph.D., ACSW Director & Associate Professor School of Social Work The University of Iowa

2. Objectives • Examine the link between mental health needs and youth offending behaviors • Identify mental health access issues for minority youth and their families • Discuss strategies to increase minority youth mental health access pre- and post- JJS involvement Reproduction of these materials only by author's explicit permission.

3. Mental HealthYouth Offending • Youth mental health issues often go unrecognized. • Minority mental health issues are more frequently unrecognized. • Youth with mental health issues often exhibit “internalizing” and “externalizing” behaviors. (Huizinga & Jakob-Chien, 1998) Reproduction of these materials only by author's explicit permission.

4. Mental HealthYouth Offending • Internalizing behaviors: • Anxiety • Depression • Behaviors reflecting low self-esteem and self-worth Reproduction of these materials only by author's explicit permission.

5. Mental HealthYouth Offending • Externalizing behavior (masking behavior): • Aggression • Violence • Substance abuse • Sexual inappropriate behavior • Other socially unacceptable (acting out) behavior Reproduction of these materials only by author's explicit permission.

6. Mental HealthYouth Offending • Masking behaviors lead to involvement with JJS. • Without proper assessment, masking behaviors become the focus of intervention. • Underlying issues may go untreated. Reproduction of these materials only by author's explicit permission.

7. Mental Health &Youth Offending Behaviors Mental health issues Externalizing behaviors Community response JJS MHS Assessment & Tx No Assessment & Tx Reproduction of these materials only by author's explicit permission.

8. Mental Health Access for Minority Youth & Families • Less access to, and availability of, mental health services • Less likely to receive needed mental health services • In treatment often receive a poorer quality of mental health care • Underrepresented in mental health research (Surgeon General,U.S. Department of Health and Human Services, 2001) Reproduction of these materials only by author's explicit permission.

9. Unique Mental Health Issues for Minority Youth and Families Social factors that negatively impact mental health – • Social and economic inequality • Exposure to racism & discrimination • Greater exposure to violence • Greater exposure to poverty (Surgeon General,U.S. Department of Health and Human Services, 2001) Reproduction of these materials only by author's explicit permission.

10. Population Specific Issues African Americans: • Need – equal rate if in the community, greater if homeless, or in foster care • Availability –“safety net providers” • Access – ~25% uninsured • Utilization – primary care, emergency room, psy. hospitals due to delay • Outcomes – more diagnostic errors Reproduction of these materials only by author's explicit permission.

11. Population Specific Issues American Indians/Native Americans • Need – disproportionate mental health problems • Availability –limited by rural isolation; fewer youth specialists in rural communities • Access – 20% uninsured • Utilization – more traditional healing • Outcomes – limited research Reproduction of these materials only by author's explicit permission.

12. Population Specific Issues Latino Americans • Need – higher rates of depressive and anxiety symptoms for youth born in U.S. • Availability –limited language appropriate services • Access – 37% uninsured (2 x rate for whites) • Utilization – more likely to use primary care • Outcomes – limited research Reproduction of these materials only by author's explicit permission.

13. Population Specific Issues Asian Americans • Need – equal; refugees higher PTSD risk • Availability – limited language appropriate services • Access – ~21% uninsured • Utilization – lower rates; high severity; ethnic matching increases uses of services • Outcomes – limited research Reproduction of these materials only by author's explicit permission.

14. Extending Mental Health Care • Reducing disparities • Increasing mental health service pre-JJS contact • Integrating mental health services post-JJS contact Reproduction of these materials only by author's explicit permission.