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ABSTRACT: We present data from interviews with 401 youths on the relationship of personal, familial, and environmental strengths to
the outcomes of urban and reservation American Indian youths. Urban youths consistently nominated more strengths than tribal
youths, except in the area of tribal strengths. Quantitative data show how those strengths relate to their school success,
daily functioning, mental health, and ethnic identity. Personal and familial strengths are related to positive school success
and functioning. Environmental strengths demonstrate complex relationships in which tribal strengths are related to increased
mental health problems and school strengths are related to fewer problems. The results of our study speak to the need to include
multiple categories of different strengths in research and to focus on strengths as well as problems in clinical interventions.
Journal of Child and Family Studies 04/2012; 16(3):331-346. · 1.12 Impact Factor
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ABSTRACT: Research supports increased risk of problem gambling (PG) and pathological gambling disorder (PGD) among individuals with substance abuse/dependence and psychiatric disorders, but studies considering personality disorder comorbidity have not adjusted for confounding relationships with other Axis I disorders. Using targeted advertising, we enrolled 153 gamblers (55% female; 32% minority; Mean age=47; SD=18.2) in a clinical validation study of the newly developed computerized gambling assessment module (C-GAM). For these analyses, we classified gamblers into three groups based on their endorsement of DSM-IV PGD: Non-gamblers (0 criteria; n=64; 44%); PG (1-4 criteria; n=60; 41%); and PGD (5-10 criteria; n=22; 15%). We evaluated PG and PGD risk associated with personality disorder pathology using the computerized structured clinical interview of DSM-IV Axis II (SCID-II). Using multinomial logistic regression, we found increased odds of PGD among individuals with greater symptoms of borderline personality disorder after adjusting for socio-demographics, substance abuse/dependence and other personality disorders significant at the bivariate level. Yet after adjusting for depressive symptoms, borderline personality disorder criteria were nonsignificant, suggesting a complex relationship between personality pathology, depression, and gambling. These findings bolster the position that further investigation is needed regarding the association of gambling pathology with personality disorders and depressive symptoms.
Journal of Psychiatric Research 03/2008; 42(13):1122-30. · 4.66 Impact Factor
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ABSTRACT: American-Indian adolescents have high rates of addiction and mental health problems but low rates of service use. The gap between service need and use appears to be even larger than the known gap for the general population, and few of the services are provided by specialists. This study examined receipt of treatment by American-Indian youths for addictions or mental health problems, the service provider who first identified a problem and sent a youth to treatment, and the extent to which the provider's knowledge and assessment predicted variance in service actions.
A sample of 401 American-Indian youths (196 from an urban area and 205 from a reservation) aged 12 to 19 years was first interviewed in person in 2001. A total of 188 of the youths' treatment providers were then interviewed.
Structural equation modeling showed that 30 percent of the variance in addictions or mental health services provided to youths was predicted by the provider's assessment of the youth's mental health, the provider's resource knowledge, and provider type.
The results demonstrate that professional, informal, and traditional providers play a pivotal role in providing treatment services offered to American-Indian youths and that these providers were more likely to identify a youth's problems and to offer and refer services when the provider knew more about community resources for the youth and about the youth's personal and environmental problems.
Psychiatric Services 09/2006; 57(8):1185-91. · 2.38 Impact Factor
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ABSTRACT: The realities of doing field research with high-risk, minority, or indigenous populations may be quite different than the guidelines presented in research training. There are overlapping and competing demands created by cultural and research imperatives. A National Institute on Drug Abuse (NIDA)-funded study of American Indian youth illustrates competing pressures between research objectives and cultural sensitivity. This account of the problems that were confronted and the attempts made to resolve them will hopefully fill a needed gap in the research literature and serve as a thought-provoking example for other researchers. This study built cross-cultural bridges. Researchers worked as a team with stakeholders to modify the instruments and methods to achieve cultural appropriateness. The researchers agreed to the communities' demands for increased service access and rights of refusal for all publications and presentations. Data indicate that these compromises did not substantially harm the first year of data collection completeness or the well-being of the youth. To the contrary, it enhanced the ability to disseminate results to those community leaders with the most vested interests. The conflicts between ideal research requirements and cultural demands confronted by the researchers and interviewers in the American Indian community were not necessarily different from issues faced by researchers in other communities. Of major import is the recognition that there are no easy answers to such issues within research.
Journal of Urban Health 07/2005; 82(2 Suppl 3):iii56-66. · 2.13 Impact Factor
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ABSTRACT: A study of American Indian youths illustrates competing pressures between research and ethics. A stakeholder-researcher team developed three plans to protect participants. The first allowed participants to skip potentially upsetting interview sections. The second called for participants flagged for abuse or suicidality to receive referrals, emergency 24-hr clinical backup, or both. The third, based on the community's desire to promote service access, included giving participants a list of service resources. Interviewers gave referrals to participants flagged as having mild problems, and reported participants with serious problems to supervisors for clinical backup. Participants seldom chose to skip sections, so data integrity was not compromised. However, participants did have more problems than expected (e.g., 1 in 3 had thought about suicide, 1 in 5 had attempted suicide, and 1 in 4 reported abuse), so service agencies were not equipped to respond. Researchers must accept the competing pressures and find ethically appropriate compromises that will not undermine research integrity.
Ethics & Behavior 04/2005; 15(1):1-14. · 0.78 Impact Factor
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ABSTRACT: A study of American Indian youths illustrates competing pressures between research and ethics. A stakeholder-researcher team developed three plans to protect participants. The first allowed participants to skip potentially upsetting interview sections. The second called for participants to skip potentially upsetting interview sections. The second called for participants flagged for abuse or suicidality to receive referrals, emergency 24-hr clinical backup, or both. The third, based on the community's desire to promote service access, included giving participants a list of service resources. Interviewers gave referrals to participants flagged as having mild problems, and reported participants with serious problems to supervisors for clinical backup. Participants seldom chose to skip sections, so data integrity was not compromised. However, participants did have more problems than expected (e.g., 1 in 3 had thought about suicide, 1 in 5 had attempted suicide, and 1 in 4 reported abuse), so service agencies were not equipped to respond. Researchers must accept the competing pressures and find ethically appropriate compromises that will not undermine research integrity.
Ethics & Behavior 02/2005; 15(1):1-14. · 0.78 Impact Factor
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ABSTRACT: We illustrate the addictions and mental health service use of American Indian adolescents. Interviews concerning mental health need and service configurations with 401 Southwestern American Indian (AI) youth used questions from the Diagnostic Interview Schedule (DIS) and the Service Assessment for Children and Adolescents (SACA). Seventy-nine percent had mental health or addiction problems, with half meeting criteria for at least one diagnosis. One in 4 youth met criteria for drug dependence'abuse or conduct disorder, 1 in 5 for depression, and 1 in 8 for alcohol dependence'abuse. Most youth were helped by a combination of providers. Youth meeting more diagnostic criteria were increasingly likely to use service configurations with adults, nonspecialist professionals, and specialists, respectively. Regardless of disorder, youth were least likely to use configurations with traditional healers or specialists and there was little difference in rates of use between the two. The lack of services from specialist providers was potentially offset by use of an extensive range of informal adults, nonspecialist professionals, and peers. Since informal helpers, peers, and nonspecialist providers, but not specialists, are providing the bulk of services they must be given support and skills so they can function effectively.
Journal of Child and Family Studies 01/2003; 12(3):319-333. · 1.12 Impact Factor
