Mental Health Services: Youth Access and
Utilization
(Also Known As Youth Services Project - YSP)
Principal Investigator:
Arlene Stiffman, PhD
Funder:
National Institute of Mental Health (NIMH) (5R24 MH 50857)
Timeframe: Funded 9/93 - 12/99
Affiliation:
Center for Mental Health Services Research (CMHSR)
Project Staff:
Ed Spitznagel, PhD, Statistician
Wendy Reich, PhD
Linda Cottler, PhD
Project Contact:
Arlene Stiffman, PhD, (314) 935-6685
arstiff@wustl.edu
Project Update
as of 1/25/08:
Stage: Project completed
Key Findings:
Description:
This longitudinal field project studied access, implementation and utilization of mental health services for 800 adolescents, ages 14-17, in St. Louis City. Teens represented equally from four arenas--legal, educational, health, child welfare--were interviewed and then followed for two years to examine their utilization of mental health services.
This project addressed the following questions:
1) To what extent do youths from each arena exhibit different mental health problems (disorders and symptoms)?
2) To what extent do the youths with mental health problems identify themselves to professionals or have their problems identified by the professionals?
3) What are the mechanisms by which the youths are provided mental health services (e.g., direct, referral), and what are the services provided?
4) What are the relationships between type and extent of mental health problems or comorbidity and being provided with or linked to mental health services?
5) What are the real and perceived barriers, gaps and deficits in mental health services?
6) How are demographic, and environmental and mental health factors associated with and moderated by social-cognitive variables (incorporating concepts of the health behavior theories) in predicting utilization?
Over the six years of the project, more than 76 GWB students worked for pay and/or practicum on this project (25+ students as interviewers in each of the two waves). Of those, 13 were doctoral students, and 4/13 were NIMH Trainees. Two of the MSW students who worked on the project went on to enter GWB's doctoral program, one of whom was also a Trainee.
Published Papers:
Lee, B.R., Munson, M.R., Ware, N.C., Ollie, M.T., Scott, L.D., McMillen, J.C. (2006). Experiences of an attitudes toward mental health services among older youths in foster care. Psychiatric Services, 57(4), 487-492.
McMillen, J.C., Zima, B.T., Scott, L.D., Auslander, W.F., Munson, M.R., Ollie, M.T., Spitznagel, E.L. (2005). The Prevalence of Psychiatric Disorders Among Older Youths in the Foster Care System. Journal of the American Academy of Child & Adolescent Psychiatry, 44(1), 88-95.
McMillen, J.C., Scott, L.D., Zima, B.T., Ollie, M.T., Munson, M.R., Spitznagel, E. (2004). Use of Mental Health Services Among Older Youths in Foster Care. Psychiatric Services, 55(7), 811-817.
Johnson, S.D., Stiffman, A., Hadley-Ives, E., & Elze, D. (2001) An analysis of stressors and comorbid mental health problems that contribute to youths’ paths to substance-specific services. The Journal of Behavioral Health Services and Research, 88, 412-425.
Stiffman, A.R. (2001) Services for Adolescents. In Lerner, JV & Lerner RM. (Eds.), Adoescence in America: An Encyclopedia. Santa Barbara, CA, ABC-CLIO. 640-649.
Stiffman, A.R. , Striley, C.W., Horvath, V., Hadley-Ives, E., Pescarino, R. (2001) Organizational context and provider perception as determinants of mental health service use. The Journal of Behavioral Health Services and Research, 28, (2), 1-17.
Elze, D., Stiffman, A.R., & Doré, P. (2000) Adolescent exposure to violence in families, neighborhoods, and schools. International Journal of Adolescent Medicine and Health, 11, 221-255.
Hadley-Ives, E., Stiffman, A.R., & Doré, P. (2000) Measuring neighborhood and school environments: Perceptual and Aggregate Approaches. Journal of Human Behavior in the Social Environment, 3 (1), 1-38.
Stiffman, A.R., Hadley-Ives, E., Dore, P., Polgar, M., Horvath, V.E., Striley, C. , Elze, D. (2000) Youths’ access to mental health services: The role of providers’ training, resource connectivity, and assessment of need. Mental Health Services Research, 2, 141-154.
Stiffman, A.R., Elze, D., Hadley-Ives, E., Johnson, S. (1999) Youth and provider perspectives on social workers’ roles in mental health services. Journal of Social Service Research, 25 (3), 83-97.
Stiffman, A.R., Hadley-Ives, E., Elze, D., Johnson, S., & Doré, P. (1999) Impact of environment on adolescents’ mental health and behavior: Structural Equation Modeling. American Journal of Orthopsychiatry, 69 (1), 73-86.
Johnson, S.D., & Stiffman, A.R. (1998) Examplar for applying research to practice: Post Traumatic Stress Disorder. In C.J. Liberton, K. Kutash, and R.M. Friedman (Eds.), Conference Proceedings: A System of Care for Children's Mental Health, Expanding the Research Base, 435-438. Tampa, FL: Research and Training Center for Children's Mental Health.
Elze, D.E., Stiffman, A.R., Dore, P. (1999). The association between types of violence exposure and youths' mental health problems. International Journal of Adolescent Medicine and Health, 11, 221-255.
Stiffman, A.R., Elze, D., Hadley-Ives, E., & Johnson, S.D. (1998 ) Service provision through gateway sectors: Who, what and where? In C.J. Liberton, K. Kutash, & R.M. Friedman (Eds.), Conference Proceedings: A System of Care for Children's Mental Health, Expanding the Research Base, 429-432. Tampa, FL: Research and Training Center for Children's Mental Health.
Williams, J.H., Stiffman, A.R., & O’Neal, J. (1998) Violence among urban African-American youths: An analysis of environmental and behavioral risk factors. Social Work Research and Abstracts, 22, 3-13.
Stiffman, A.R., Chen, Y.W., Elze, D., Doré, P., & Cheng., L.C. (1997) Adolescents’ and providers’ perspectives on the need for and use of mental health services. Journal of Adolescent Health, 21(5), 335-342.
Chen, Y.W., Stiffman, A.R., Cheng, L.C., & Doré, P. (1997) Gender differences and adolescent sexual risk behaviors: Mental health problems and social environment. Journal of Child and Family Studies, 6, 9-25.
Conference Presentations:
Elze, D., & Stiffman, A (1999). Adolescents’ Pathways to Specialty Mental Health Services. Presented at the Third Annual Conference of the Society for Social Work and Research, Austin, Texas.
Elze, D., & Stiffman, A. (1999). Increasing Response Rates of Adolescent Participants in Longitudinal Research, in Implementing Field Research projects: The Nitty Gritty of Obtaining Valid Responses and Maintaining Data Quality. Presented at the Third Annual Conference of the Society for Social Work and Research, Austin, Texas.
Johnson, S.D., & Stiffman, A. (1999, January). The role of family in the mental health of youth. Presented at the Society Social Work Research Annual Conference, Austin, TX.
Constantine, J., Stiffman, A.R., & Polgar, M. (1999, January). Challenges faced by specialty and nonspecialty mental health service providers in the referral process. Presented at the Society for Social Work and Research, Austin, TX.
Polgar, M., Stiffman, A.R., & Gillespie, D. (1999, March). Measuring social networks in the study of youth service systems. Presented at the 45th Annual Program Meeting of the Council on Social Work Education. San Francisco.
Stiffman, A.R., Hadley-Ives, E., Elze, D., Johnson, S.D. & Doré, P. (1998, July). Access to Mental Health Services Through Primary Care and Other Gateways: A Person in Environment Perspective. Presented at the Twelfth International Conference on Mental Health Problems in the General Health Care Sector. Washington, DC.
Johnson, S.D., & Stiffman, A.R. (1998, November). The role of mental health in the reduction of youth violence. Presented at the Annual American Public Health Conference, Washington, D.C.
Hadley-Ives, E., Stiffman, A.R., Elze, D., & Johnson, S. (1998, March). Youth Perceptions of the Mental Health Care Systems. Presented at the 11th annual conference on Service System Research. Tampa.
Elze, D., & Stiffman, A.R. (1998, March). It Takes Education to Launch a Future. Presented at the Council on Social Work Education APM, Orlando.
Stiffman, A.R., Elze, D., Hadley-Ives, E., Johnson, S.D., Constantine, J., O’Neal, J., & Liu, L.W. (1998, January). Youth and Provider Perspectives on Mental Health Services. Presented at the International Conference on Research for Social Work Practice, Society for Social Work and Research, North Miami, FL.
Elze, D., Stiffman, A.R., & Doré, P. (1997, November). Preventing school drop out: A social work and public health emergency. Presented at the American Public Health Association, 125th Annual Meeting, Indianapolis, IN.
Hadley-Ives, E., O’Neal, J, Constantine, J. Liu, L.W., & Stiffman, A.R. (1997, September). Provider and organizational characteristics for effective adolescent mental health services. The Seventh Annual Virginia Beach Conference. Presented at the Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia.
Johnson, S.D., & Stiffman, A.R. (1997, September). Internal and External Violence in Adolescents: Implications for service delivery. Presented at the Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia.
Elze, D.E., Johnson, S.D., & Stiffman, A.R. (1997, September). Adolescents’ Pathways to Mental Health Services through Specialty and Nonspecialty Providers. Presented at the Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia.
Elze, D., Stiffman, A.R., & Doré, P. (1997, November). Preventing school drop out: A social work and public health emergency. Presented at the American Public Health Association, 125th Annual Meeting, Indianapolis, IN.
Stiffman, A.R., Elze, D., Johnson, S.D., & Hadley-Ives, E. (1997, September). Specialty and nonspecialty providers of mental health services to adolescents. Presented at the NIMH International Research Conference on Mental Health. Washington, DC.
Stiffman, A.R. Elze, D.E., Hadley Ives, E., & Johnson, S.D. (1997, September). Provision of Adoelscent Mental Health Services: To Whom and Why? Present at the Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia.
Stiffman, A.R., Elze, D.E., Hadley Ives, E., Johnson, S.D. & Dore, P. (1997, September). Youth and provider perspectives on mental health services: Symposium. Presented at the 7th Annual Conference on Children and Adolescents with Emotional and Behavioral Disorders.
Elze, D., & Stiffman, A.R. (1997, June). The impact of family and community violence on urban adolescents' mental and physical health. Presented at the 5th International Family Violence Research Conference, Durham, NH.
Stiffman, A.R., Elze, D., Hadley-Ives, E., Johnson, S., Doré, P., Dinan, A., Ringenberg, M., & Satwa, R. (1997, February). Symposium: The Youth Services Project: Mental Health Services through Public Service Sectors. Presented at the 10th annual conference on Service System Research. Tampa, February.
Elze, D., Satwah, R., & Stiffman, A.R. (1997, February). Tracking urban adolescents longitudinally: Lessons from the field. Presented at the 10th Annual Research Conference. A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL.
Hadley-Ives, E., & Stiffman, A.R. (1997, February). Stigma, self-efficacy, normative beliefs, and ethnicity in service use. Presented at the 10th Annual Research Conference. A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL.
Johnson, S., & Stiffman, A.R. (1997, February). Exemplar for applying research to practice: post traumatic stress disorder. Presented at the 10th Annual Research Conference. A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL.
Dinan, B.A., Ringenberg, M.C., & Stiffman, A.R. (1997, February). Help seeking as impacted by family, peer and professional support. Presented at the 10th annual conference on Service System Research. Tampa, FL.
Hadley-Ives, E., & Stiffman, A.R. (1997, September). Provider and organizational characteristics for effective adolescent mental health services. Presented at the Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia.
Johnson, S.D., & Stiffman, A.R. (1997, March). Is a culturally-specific substance use intervention model needed for African-American adolescents? Presented at the American Orthopsychiatric Association 74th Annual Meeting. Toronto.
Stiffman, A.R., Hadley-Ives, E., Elze, D., Johnson, S., Dinan, A., & Ringenberg, M. (1997, March). The association of real and perceived environment with adolescent mental health and behavior. American Orthopsychiatric Association 74th Annual Meeting. Toronto.
Stiffman, A.R., Hadley-Ives, E., Elze, D., Johnson, S., Dinan, A., & Ringenberg, M. (1997, March). Why the gap between providers and adolescents on their need for mental health services? American Orthopsychiatric Association 74th Annual Meeting. Toronto.
Stiffman, A.R., Chen, Y.W., Elze, D., Doré, P., & Hadley-Ives, E. (1996, November). The role of health, education, social service, and juvenile justice in adolescents’ use of mental health services. Presented at APHA. New York, NY.
Stiffman, A.R., Chen, Y.W., Elze, D., Doré, P., & Hadley-Ives, E. (1996, November). The impact of stress and exposure to violence on inner city adolescents’ physical health. Presented at APHA. New York, NY.
Elze, D., Stiffman, A.R., Chen, Y.W., Doré, P., & Hadley-Ives, E. (1996, November). Perceptions of Barriers to Services Among Inner-City Adolescents from Gateway Sectors: A Challenge to Providers. Presented at APHA. New York, NY.
Stiffman, A.R., Hadley-Ives, E., & Doré, P (1996, October). The association of objective and perceived environment with adolescent mental health. Presented at the 6th Annual Virginia Beach Conference: Children and Adolescents with Emotional and Behavioral Disorders. Virginia Beach, NC.
Elze, D., Stiffman, A.R., & Doré, P. (1996, June). Family violence as a predictor of runaway behavior among adolescent females. Presented at the National Conference on Children Exposed to Family Violence. Austin, TX.
Elze, D., Stiffman, A.R., & Doré, P. (1996, July). Gender differences in the predictors of runaway behavior among inner-city adolescents: Family and neighborhood influences and mental health problems. Presented at Adolescent Services & Policy: From Gender Sensitive to Gender Competent. Lincoln, NE.
Stiffman, A.R., Chen, Y.W., Elze, D., Doré, P, & Cheng, L.C. (1996, February). Adolescents’ and providers’ perspectives on the need for and use of mental health services. Presented at the Research and Training Center for Children’s Mental Health. Ninth Annual Conference on Service System Research. Tampa FL.
Elze, D., Stiffman, A.R., Compton, W., & Cottler, L. (1996, February). Understanding the mental health system in rural and urban Missouri. Presented at the Research and Training Center for Children’s Mental Health. Ninth Annual Conference on Service System Research. Tampa FL.
Chen, Y.W., Stiffman, A.R., & Elze, D. (1996, February). Matching mental health services to adolescent mental health problems. Presented at the Research and Training Center for Children’s Mental Health. Ninth Annual Conference on Service System Research. Tampa, FL.
Stiffman, A.R., Doré, P., Cheng, L.C., & Chen, Y.W. (1995, October). The impact of exposure to violence on youths’ mental health and violent behavior. Presented at APHA 123rd Annual Meeting, San Diego, CA.
Cheng, L.C., & Stiffman, A.R. (1995, October). Family structure and adolescent conduct disorder: Family structure versus social capital? Presented at Social Work ‘95: NASW’s Meeting of the Profession, Philadelphia, PA.
Stiffman, A.R., & Doré, P. (1995, October). The impact of person and environment on youths’ violent behavior. Presented at Social Work ‘95: NASW’s Meeting of the Profession, Philadelphia, PA.
Williams, J.H., Stiffman, A.R., & O’Neal, J. (1995, October). Environmental and behavioral factors associated with violence among urban African American youths. Presented at the Midwestern Criminological Association Annual Meeting, Chicago IL.
Chen, Y.W., & Stiffman, A.R. (1995, September). Psychological and social correlates of adolescent HIV/AIDS sexual risk behaviors. Presented at the 5th Annual Virginia Beach Conference Virginia Beach, VA.
Cheng, L.C., & Stiffman, A.R. (1995, September). Families and adolescent conduct disorder: Family structure versus social environment. Presented at the 5th Annual Virginia Beach Conference, Virginia Beach, VA,.
Stiffman, A.R., Cheng, L.C., Chen, Y.W., Elze, D., & Doré, P. (1995, September). Adolescents and gateway providers: Need, availability, and use of mental health services. Presented at the Ninth Annual NIMH International Research Conference on Mental Health Problems in the General Health Care Sector, Bethesda MD.
Stiffman, A.R., & Doré, P. (1995, April). Predictors of high risk adolescent behaviors: Support for the unique social work perspective on person and environment. Presented at Advancing Knowledge for Human Services: A National Conference of Social Work Researchers. IASWR and the Society for Social Work Research, Arlington VA.
Stiffman, A.R., Cheng, L.C., Chen, Y.W., & Doré, P. (1995, March). Adolescent mental health problems and health clinic treatment. Presented at the Eighth Annual Research Conference for Children’s Mental Health, Tampa, FL.
Stiffman, A.R., & Doré, P. (1995, October). A person-environment model for social work public health interventions. Presented at the APHA 122nd Annual Meeting, Washington, DC.
Stiffman, A.R., Cheng, L.C., Chen, Y.W., & Doré, P. (1994, October). Social workers as gatekeepers of mental health services for teens. Presented at the APHA 122nd Annual Meeting, Washington, DC.