This study analyzed patterns of outpatient mental health service use from adolescence into early adulthood among young adults who were reported as victims of maltreatment in adolescence.
Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children for whom maltreatment was investigated by the child welfare system. The sample consisted of 616 young adults aged 12 to 15 at baseline. Analysis used descriptive statistics to determine need for and use of outpatient mental health services across time. Logistic regression was used to examine predictors of use of outpatient mental health services in young adulthood.
Almost half of the young adults in this sample had one or more indicators of mental health problems. There was a significant decrease in use of specialty mental health services from adolescence to young adulthood, declining from 47.6% at baseline, to 14.3% at the five- to six- year follow-up. Among young adults with mental health problems, less than a quarter used outpatient mental health services. Logistic regression results indicated that having mental health problems, having Medicaid, and being white were positively associated with use of outpatient mental health services in young adulthood.
Mental health problems were prevalent among young adults who were suspected of being maltreated when they were adolescents, but only about a quarter of those in need used outpatient mental health services. Interventions to improve access to outpatient mental health services for this vulnerable population should particularly support outreach and engagement of young adults who are uninsured and from racial or ethnic minority groups with a history of involvement with the child welfare system in order to meet their unique developmental needs.
"Nationally, the percentage of youth exposed to some form of trauma is high, ranging from 8% to 53%, depending on the type of trauma and population studied (e.g., Copeland, Keeler, Angold, and Costello, 2007; Finkelhor, Ormrod, Turner, and Hamby, 2005; U.S. Department of Health and Human Services, 2011). Despite high rates of subsequent related post-traumatic stress disorder (PTSD), and other symptomatologies , many children who have experienced trauma either do not receive treatment or receive treatment that has not proven to be effective (Burns et al., 2004; Cohen, Mannarino, and Rogal, 2001; Kolko, Cohen, Mannarino, Baumann, and Knudsen, 2009; Ringeisen, Casanueva, Urato, and Stambaugh, 2009). Without adequate and appropriate treatment, trauma symptoms may linger or exacerbate over time, developing into other mental health problems such as internalizing or externalizing disorders (Hamblen, 1999; Hernandez, Lodico, and DiClemente, 1993; Hoven et al., 2005; Siegel and Williams, 2003). "
[Show abstract][Hide abstract] ABSTRACT: Despite evidence linking childhood trauma to subsequent social, emotional, psychological, and cognitive problems, many children who have experienced trauma do not receive mental health treatment that has been proven to be effective. Large-scale dissemination of evidence-based practices (EBPs) is one possible solution to enhance the current negative state of mental health treatment for these children. This article describes a dissemination effort of an EBP (i.e., Trauma-Focused Cognitive-Behavioral Therapy [TF-CBT]) for childhood symptoms of post-traumatic stress disorder throughout Arkansas. The effort targeted mental health professionals within child advocacy centers and community mental health centers across the state. The article describes the process of dissemination and implementation. Lessons learned and recommendations for future dissemination efforts are highlighted.
Children and Youth Services Review 06/2013; 35(6):1023–1029. DOI:10.1016/j.childyouth.2013.03.012 · 1.27 Impact Factor
"The TRACK study found that less than 5 per cent of adolescents who made the transition received optimal care at the time . Ringeisen, Casanueva, Urato, and Stambaugh [; USA, n = 616; aged 12-15 at baseline and followed up 5-6 years later] report on a study of young adults who had been investigated for child maltreatment in their adolescence by the child welfare systems. They also found a significant decrease in the use of specialist mental health services in the transition from adolescent to young adulthood, declining from 47.6% at baseline to 14.3% on follow-up. "
[Show abstract][Hide abstract] ABSTRACT: There were 59,500 Children in out-of-home care in England in 2008. Research into this population points to poor health and quality of life outcomes over the transition to adult independence. This undesirable outcome applies to mental health, education and employment. This lack of wellbeing for the individual is a burden for health and social care services, suggesting limitations in the current policy approaches regarding the transitional pathway from care to adult independence. Although the precise reasons for these poor outcomes are unclear long term outcomes from national birth cohorts suggest that mental health could be a key predictor for subsequent psychosocial adjustment.
Researching the wellbeing of children in out-of-home care has proven difficult due to the range and complexity of the factors leading to being placed in care and the different methods used internationally for recording information. This paper delineates the estimated prevalence of mental health problems for adolescents in the care system, organisational factors, influencing service provision, and pathways through the transition from adolescence to independent young adult life. The extent to which being taken into care as a child moderates adult wellbeing outcomes remains unknown. Whether the care system enhances, reduces or has a null effect on wellbeing and specifically mental health cannot be determined from the current literature. Nonetheless a substantial proportion of young people display resilience and experience successful quality of life outcomes including mental capital. A current and retrospective study of young people transitioning to adult life is proposed to identify factors that have promoted successful outcomes and which would be used to inform policy developments and future longitudinal studies.
Health Research Policy and Systems 05/2010; 8(1):10. DOI:10.1186/1478-4505-8-10 · 1.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The main objective of this study is to explore the relationship of psychotropic medication use patterns and clinician-reported maltreatment status in Medicaid-insured youth. This cross-sectional study analyzed computerized outpatient claims for youth aged 2–17 years who were continuously enrolled for ≥10 months in a mid-Atlantic state Medicaid program in 2006. Bivariate analyses and multivariable logistic modeling were employed to assess patterns of any psychotropic drug use, and specifically for antipsychotics, antidepressants, and stimulants by clinician-reported maltreatment status and according to other study covariates. Child maltreatment status was assessed using ICD-9 codes for maltreatment. Other covariates included age group, gender, race/ethnicity, region, Medicaid-eligibility categories, and clinician-reported psychiatric diagnostic groups. Among 274,490 youth, 901 had a clinician-reported child maltreatment indicator for a prevalence of 3.3 per 1,000. These youth were more likely to be older, female, African American, and Medicaid eligible by foster care or disability. Youth with clinician-reported maltreatment compared to youth without identified maltreatment had a significantly higher prevalence of antipsychotic use (14.1 vs. 3.4 %), antidepressant use (12.1 vs. 3.4 %) and stimulant use (15.8 vs. 7.8 %). After adjusting for the study covariates, the odds of antipsychotic use (2.6 [2.0, 3.2]), antidepressant use (2.0 [1.6, 2.6]), and any psychotropic use (1.5 [1.3, 1.9]) were comparatively higher among youth with clinician-reported maltreatment. By contrast, the adjusted-odds of stimulant use was comparable between the groups. The findings from this exploratory study from one state’s Medicaid outpatient data suggest that youth with maltreatment indicators have an increased likelihood of antipsychotic and antidepressant medication dispensings.
Journal of Child and Family Studies 05/2014; 23(4). DOI:10.1007/s10826-013-9713-6 · 1.42 Impact Factor
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