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 01/22/2008:
Stage: Project completed
Key Findings:
- Findings show the gap between the need for mental health services and the services provided
- The high rates of violence to which youths were exposed, and the relationship of violence to mental health problems
- Youth and provider perspectives on social workers’ roles in mental health service delivery
- The impact of environments on adolescents’ mental health and behavior
- The key role social workers and non-specialty sectors play in mental health service provision
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.
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., 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:
1999 Elze, D., & Stiffman, A. Adolescents’ Pathways to Specialty Mental Health Services. Third Annual Conference of the Society for Social Work and Research, Austin, Texas.
1999 Elze, D., & Stiffman, A. 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. Third Annual Conference of the Society for Social Work and Research, Austin, Texas.
1999 Johnson, S.D., & Stiffman, A. The role of family in the mental health of youth. Society Social Work Research Annual Conference, Austin, TX (January).
1999 Constantine, J., Stiffman, A.R., & Polgar, M. Challenges faced by specialty and nonspecialty mental health service providers in the referral process. Society for Social Work and Research, Austin, TX, January.
1999 Polgar, M., Stiffman, A.R., & Gillespie, D. Measuring social networks in the study of youth service systems. The 45th Annual Program Meeting of the Council on Social Work Education. San Francisco, March.
1998 Stiffman, A.R., Hadley-Ives, E., Elze, D., Johnson, S.D. & Doré, P. Access to Mental Health Services Through Primary Care and Other Gateways: A Person in Environment Perspective. The Twelfth International Conference on Mental Health Problems in the General Health Care Sector. Washington, DC, July 13-14.
1998 Johnson, S.D., & Stiffman, A.R. The role of mental health in the reduction of youth violence. Annual American Public Health Conference, Washington, D.C., November.
1998 Hadley-Ives, E., Stiffman, A.R., Elze, D., & Johnson, S. Youth Perceptions of the Mental Health Care Systems. The 11th annual conference on Service System Research. Tampa, March.
1998 Elze, D., & Stiffman, A.R. It Takes Education to Lauch a Future. Council on Social Work Education APM, Orlando, March.
1998 Stiffman, A.R., Elze, D., Hadley-Ives, E., Johnson, S.D., Constantine, J., O’Neal, J., & Liu, L.W. Youth and Provider Perspectives on Mental Health Services. International Conference on Research for Social Work Practice, Society for Social Work and Research, North Miami, FL, January 24-26, 1998.
1997 Elze, D., Stiffman, A.R., & Doré, P. Preventing school drop out: A social work and public health emergency. American Public Health Association, 125th Annual Meeting, Indianapolis, IN, November 9-13, 1997.
1997 Hadley-Ives, E., O’Neal, J, Constantine, J. Liu, L.W., & Stiffman, A.R. Provider and organizational characteristics for effective adolescent mental health services. The Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia, September.
1997 Johnson, S.D., & Stiffman, A.R. Internal and External Violence in Adolescents: Implications for service delivery. The Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia, September.
1997 Elze, D.E., Johnson, S.D., & Stiffman, A.R. Adolescents’ Pathways to Mental Health Services through Specialty and Nonspecialty Providers. The Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia, September.
1997 Elze, D., Stiffman, A.R., & Doré, P. Preventing school drop out: A social work and public health emergency. American Public Health Association, 125th Annual Meeting, Indianapolis, IN, November 9-13, 1997.
1997 Stiffman, A.R., Elze, D., Johnson, S.D., & Hadley-Ives, E. Specialty and nonspecialty providers of mental health services to adolescents. NIMH International Research Conference on Mental Health. Washington, DC, September.
1997 Stiffman, A.R. Elze, D.E., Hadley Ives, E., & Johnson, S.D. Provision of Adoelscent Mental Health Services: To Whom and Why? The Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia, September.
1997 Stiffman, A.R., Elze, D.E., Hadley Ives, E., Johnson, S.D. & Dore, P. Youth and provider perspectives on mental health services: Symposium. 7th Annual Conference on Children and Adolescents with Emotional and Behavioral Disorders, September.
1997 Elze, D., & Stiffman, A.R. The impact of family and community violence on urban adolescents' mental and physical health. The 5th International Family Violence Research Conference, Durham, NH, June 29-July 2.
1997 Stiffman, A.R., Elze, D., Hadley-Ives, E., Johnson, S., Doré, P., Dinan, A., Ringenberg, M., & Satwa, R. Symposium: The Youth Services Project: Mental Health Services through Public Service Sectors. The 10th annual conference on Service System Research. Tampa, February.
1997 Elze, D., Satwah, R., & Stiffman, A.R. Tracking urban adolescents longitudinally: Lessons from the field. The 10th Annual Research Conference. A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL, February 23-26.
1997 Hadley-Ives, E., & Stiffman, A.R. Stigma, self-efficacy, normative beliefs, and ethnicity in service use. The 10th Annual Research Conference. A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL, February 23-26.
1997 Johnson, S., & Stiffman, A.R. Exemplar for applying research to practice: post traumatic stress disorder. The 10th Annual Research Conference. A System of Care for Children’s Mental Health: Expanding the Research Base, Tampa, FL, February 23-26.
1997 Dinan, B.A., Ringenberg, M.C., & Stiffman, A.R. Help seeking as impacted by family, peer and professional support. The 10th annual conference on Service System Research. Tampa, FL, February.
1997 Hadley-Ives, E., & Stiffman, A.R. Provider and organizational characteristics for effective adolescent mental health services. The Seventh Annual Virginia Beach Conference. Children and Adolescents with Emotional and Behavioral Disorders, Virginia Beach, Virginia, September.
1997 Johnson, S.D., & Stiffman, A.R. Is a culturally-specific substance use intervention model needed for African-American adolescents? American Orthopsychiatric Association 74th Annual Meeting. Toronto, March.
1997 Stiffman, A.R., Hadley-Ives, E., Elze, D., Johnson, S., Dinan, A., & Ringenberg, M. The association of real and perceived environment with adolescent mental health and behavior. American Orthopsychiatric Association 74th Annual Meeting. Toronto, March.
1997 Stiffman, A.R., Hadley-Ives, E., Elze, D., Johnson, S., Dinan, A., & Ringenberg, M. Why the gap between providers and adolescents on their need for mental health services? American Orthopsychiatric Association 74th Annual Meeting. Toronto, March.
1996 Stiffman, A.R., Chen, Y.W., Elze, D., Doré, P., & Hadley-Ives, E. The role of health, education, social service, and juvenile justice in adolescents’ use of mental health services. APHA. New York, NY, November.
1996 Stiffman, A.R., Chen, Y.W., Elze, D., Doré, P., & Hadley-Ives, E. The impact of stress and exposure to violence on inner city adolescents’ physical health. APHA. New York, NY, November.
1996 Elze, D., Stiffman, A.R., Chen, Y.W., Doré, P., & Hadley-Ives, E. Perceptions of Barriers to Services Among Inner-City Adolescents from Gateway Sectors: A Challenge to Providers. APHA. New York, NY, November.
1996 Stiffman, A.R., Hadley-Ives, E., & Doré, P. The association of objective and perceived environment with adolescent mental health. The 6th Annual Virginia Beach Conference: Children and Adolescents with Emotional and Behavioral Disorders. Virginia Beach, NC, October.
1996 Elze, D., Stiffman, A.R., & Doré, P. Family violence as a predictor of runaway behavior among adolescent females. National Conference on Children Exposed to Family Violence. Austin, TX, June 6-8.
1996 Elze, D., Stiffman, A.R., & Doré, P. Gender differences in the predictors of runaway behavior among inner-city adolescents: Family and neighborhood influences and mental health problems. Adolescent Services & Policy: From Gender Sensitive to Gender Competent. Lincoln, NE, July 18-19.
1996 Stiffman, A.R., Chen, Y.W., Elze, D., Doré, P, & Cheng, L.C. Adolescents’ and providers’ perspectives on the need for and use of mental health services. The Research and Training Center for Children’s Mental Health. Ninth Annual Conference on Service System Research. Tampa FL, February.
1996 Elze, D., Stiffman, A.R., Compton, W., & Cottler, L. Understanding the mental health system in rural and urban Missouri. The Research and Training Center for Children’s Mental Health. Ninth Annual Conference on Service System Research. Tampa FL, February.
1996 Chen, Y.W., Stiffman, A.R., & Elze, D. Matching mental health services to adolescent mental health problems. The Research and Training Center for Children’s Mental Health. Ninth Annual Conference on Service System Research. Tampa, FL, February 26-28.
1995 Stiffman, A.R., Doré, P., Cheng, L.C., & Chen, Y.W. The impact of exposure to violence on youths’ mental health and violent behavior. APHA 123rd Annual Meeting, San Diego, CA, October 29-November 2.
1995 Cheng, L.C., & Stiffman, A.R. Family structure and adolescent conduct disorder: Family structure versus social capital? Social Work ‘95: NASW’s Meeting of the Profession, Philadelphia, PA, October 12-October 15.
1995 Stiffman, A.R., & Doré, P. The impact of person and environment on youths’ violent behavior. Social Work “95: NASW’s Meeting of the Profession, Philadelphia, PA, October 12-October 15.
1995 Williams, J.H., Stiffman, A.R., & O’Neal, J. Environmental and behavioral factors associated with violence among urban African American youths. Midwestern Criminological Association Annual Meeting, Chicago IL, October 5.
1995 Chen, Y.W., & Stiffman, A.R. Psychological and social correlates of adolescent HIV/AIDS sexual risk behaviors. Virginia Beach, VA, 5th Annual Virginia Beach Conference, September 28-October 3.
1995 Cheng, L.C., & Stiffman, A.R. Families and adolescent conduct disorder: Family structure versus social environment. Virginia Beach, VA, 5th Annual Virginia Beach Conference, September 28-October 3.
1995 Stiffman, A.R., Cheng, L.C., Chen, Y.W., Elze, D., & Doré, P. Adolescents and gateway providers: Need, availability, and use of mental health services. Ninth Annual NIMH International Research Conference on Mental Health Problems in the General Health Care Sector, Bethesda MD, September 11-12.
1995 Stiffman, A.R., & Doré, P. Predictors of high risk adolescent behaviors: Support for the unique social work perspective on person and environment. Advancing Knowledge for Human Services: A National Conference of Social Work Researchers. IASWR and the Society for Social Work Research, Arlington VA, April.
1995 Stiffman, A.R., Cheng, L.C., Chen, Y.W., & Doré, P. Adolescent mental health problems and health clinic treatment. The Eighth Annual Research Conference for Children’s Mental Health, Tampa, FL, March 6-March 8.
1994 Stiffman, A.R., & Doré, P. A person-environment model for social work public health interventions. APHA 122nd Annual Meeting, Washington, DC, Oct. 30-Nov. 3.
1994 Stiffman, A.R., Cheng, L.C., Chen, Y.W., & Doré, P. Social workers as gatekeepers of mental health services for teens. APHA 122nd Annual Meeting, Washington, DC, Oct. 30-Nov. 3.