Faculty Bibliography

Mental health service underutilization among African American adolescents is well documented, yet not fully understood. Discordance between adolescents and their parents on perceived need for seeing a counselor for an emotional need or psychiatrist for psychiatric or medical services may help explain low service use among this population. This exploratory, prospective study examined the relationship between parent-adolescent concordance on perceived need for emotional counseling or psychiatric services and mental health service use. The relationships between gender and perceived service need and concordance and adolescent severity of depressive symptoms were also explored. Parent-adolescent dyads (n=108) receiving community-based adolescent outpatient mental health services responded to interview questions concerning their perception of whether an emotional counselor and a psychiatrist were needed in the past six months. Findings revealed low parent-adolescent concordance on perceived need for an emotional counselor and a psychiatrist. A greater proportion of adolescents reported a need than parents. There was no association between gender and perceived need for an emotional counselor and a psychiatrist. Lower rates of parent-adolescent concordance were found among youth reporting elevated depressive symptoms compared to youth reporting normal range symptoms. Concordant dyads kept a higher number of appointments than discordant dyads. Implications for clinical social work practice and future research are discussed.

African American adolescent boys underutilize mental health service due to stigma associated with depression. Gaining an increased understanding of how depressed, African American adolescent boys perceive their mental health needs and engage in help-seeking behaviors might play an essential role in efforts to improve their symptoms and access to care. Using a mixed-methods design, this study examined the influence of mental health stigma and social support on depressive symptoms among African American adolescent boys. Findings indicated the protective effects of social support in decreasing depressive symptoms, especially when participants experienced mental health stigma. Results also revealed the pivotal role of family social support over both professional and peer support for participants who struggled with depressive symptoms. The primacy of family support among the sample, combined with the frequent distrust of professionals and peer networks, would indicate that working with families may improve initial identification of depression among African American adolescent boys and decrease their barriers to care.

PURPOSE: To examine the associations between the size and quality of African-American adolescents' social networks and their mental health service use, and to examine whether these social network characteristics moderate the association between need for services because of emotional or behavioral difficulties and use of services. METHOD: Participants were a community sample of African-American adolescents (N = 465; 46.2% female; mean age, 14.78) initially recruited in 1st grade for participation in an evaluation of two preventive intervention trials. Social network influences and adolescents' mental health service use in schools and community were accessed. RESULTS: A significant positive association between adolescents' perception that their social network was helpful and their use of school mental health services was identified. The significant associations between need for services for anxiety, depression, or behavior problems, and school and outpatient service use were moderated by size of the social network. Specifically, among youth in need of services for anxiety or depression, school-based service use was higher for those with larger social networks. CONCLUSIONS: Implications for enhancing access to formal mental health services include further examination of key social network influences that potentially serve as facilitators or barriers to formal help-seeking. The findings also suggest that it might be important to integrate social network members into interventions to address the mental health needs of adolescents.

PURPOSE: We examined the social and clinical factors associated with arrival status (e.g., involuntary versus voluntary) and civil commitment decisions in psychiatric emergency services (PES) to assess African-American youths' help-seeking patterns and entree into care. METHODS: Patient records were reviewed for 1621 African-American youth from an inner-city PES between October 2001 and September 2002. Multivariate logistic regression was used to examine the social and clinical factors associated with arrival status (e.g., involuntary vs. voluntary admission) and case disposition among youth who were involuntarily and voluntarily admitted (e.g., disposition upheld vs. dismissed). RESULTS: Low-income youth with behavior disorders were less likely to arrive voluntarily to PES. Medical insurance, suicidality, DSM diagnosis, substance involvement, Global Assessment of Function (GAF) scores and time of day the youth arrived to PES were predictors of voluntary arrival. Older age and GAF scores significantly predicted the decision to uphold an involuntary commitment. Age (younger age less likely), higher GAF scores, insurance status, substance abuse involvement and arrival time (evening shift) significantly predicted the decision to uphold a voluntary decision. IMPLICATIONS: Our findings suggest that psychiatric and nonpsychiatric factors influence both how African-American youth arrive to PES and the decisions made regarding their voluntary/involuntary commitment.

Objective: This study examines the impact of the Family Connections (FC) intervention on preventing behavioral problems among urban, predominantly African American children at risk of neglect. Method: Secondary data analyses using mixed model analyses of variance (ANOVA) with repeated measures were used to examine gender differences in child behavior outcomes among 111 participating families across three time points (intake, closing, and 6 months following intervention participation). Results: From intake to closing, boys appeared to experience a larger decrease in internalizing and externalizing behaviors than girls. At 6-month follow-up, boys' behaviors remained stable relative to results at closing; girls showed a slight decrease in behaviors over the same period. Findings also indicate a greater decrease in problem behaviors for participants in the 9-month versus 3-month version of FC. Conclusions: Positive effects of the FC intervention for African American children indicate the potential of this prevention intervention to avert negative behavior trajectories.

Objective: The purpose of this study is to assess the reliability and validity of the North Carolina Family Assessment Scale (NCFAS) among families involved with youth mental health services. Methods: Using NCFAS data collected by child mental health intake workers with 158 families, factor analysis was conducted to assess factor structure, and thematic analysis of intake notes was used to test content validity. Results: This study found only three NCFAS subscales. The case notes included themes specific to youth with mental health needs that were not captured by current NCFAS items. Conclusions: This study suggests variation in the fit for the NCFAS in child mental health services compared to the measurement properties established in child welfare samples.

In this study, the authors examined the combined effects of caregiver mental health, alcohol use, and social network support/satisfaction on child mental health needs among African American caregiver-child dyads at risk of maltreatment. The sample included 514 eight-year-old African American children and their caregivers who participated in the Longitudinal Studies of Child Abuse and Neglect. A structural equation model was created with caregiver mental health/alcohol use and caregiver social network support/satisfaction as the exogenous variables and child mental health need as the endogenous variable. Caregivers with less-supportive networks and whose capacity to parent was challenged by alcohol, depression, or other mental health problems had children with elevated mental health needs. These findings confirm the need to examine the effects of caregiver influences (for example, caregiver mental health and social network support/satisfaction) on mental health among African American children at risk of maltreatment and to further explain how the social networks of caregivers are accessed when caregivers and children have mental health problems. Implications for identifying mental health needs among this vulnerable group and improving their connections to formal mental health services through social network-level interventions are discussed.