Waldo Jennifer A, Henderson Craig, Dauber Sarah, Hogue Aaron
Sam Houston State University, Huntsville, TX 77341.
Sam Houston State University, Campus Box 2447, Huntsville, TX 77341.
Child Youth Serv Rev. 2021 Feb;121. doi: 10.1016/j.childyouth.2020.105811. Epub 2020 Dec 11.
Of adolescents utilizing behavioral health services, between 45% and 62% (Farmer et al., 2003; Merikangas et al., 2011) become involved in multiple systems (i.e., mental health, juvenile justice, child welfare, and education systems) to meet their behavioral health needs (e.g., Glisson & Green, 2006). Despite their involvement in treatment, these youths often still have unmet needs due to lack of integrated care across systems (e.g., Hawkins, 2009). Adolescent behavior problems may be conceptualized differently to account for the unique needs of youth involved in multiple systems. Using a sample of 433 youth in need of behavioral health treatment services, we: (1) identified distinct classes of systems involvement across four systems, (2) compared youth comprising these classes on demographics and DSM-IV diagnoses, and (3) examined changes in delinquency and substance use over time among the youth comprising the systems involvement class groupings. Using latent class analysis, we identified two distinct classes of adolescent systems involvement: one with heavy involvement in all systems and the other with high involvement in only the education and mental health systems. Latent growth curve analyses using most likely class membership as a predictor demonstrated that adolescents with heavy involvement in all systems showed significantly more decreases in delinquent activity than comparison youth, but less decreases in substance use over a one-year follow-up period. Our findings support that it is clinically useful to examine classes of multiple systems involvement. Treatment providers can use these findings identify whether or not their clients are heavily involved in all systems and tailor their approach accordingly. In addition, researchers can continue to parse out differences in treatment trajectories for multiple systems involved youth as well as the various factors impacting these differences.
在使用行为健康服务的青少年中，45%至62%（法默等人，2003年；梅里坎加斯等人，2011年）会涉及多个系统（即心理健康、少年司法、儿童福利和教育系统）以满足其行为健康需求（例如，格利森和格林，2006年）。尽管他们接受了治疗，但由于各系统间缺乏综合护理，这些青少年的需求往往仍未得到满足（例如，霍金斯，2009年）。青少年行为问题的概念化方式可能有所不同，以考虑涉及多个系统的青少年的独特需求。我们以433名需要行为健康治疗服务的青少年为样本，：（1）确定了四个系统中不同的系统参与类别，（2）比较了构成这些类别的青少年在人口统计学和《精神疾病诊断与统计手册》第四版诊断方面的情况，（3）研究了构成系统参与类别分组的青少年随时间推移在犯罪和物质使用方面的变化。通过潜在类别分析，我们确定了两类不同的青少年系统参与情况：一类是在所有系统中都有大量参与，另一类是仅在教育和心理健康系统中有大量参与。使用最可能的类别成员身份作为预测指标的潜在增长曲线分析表明，在所有系统中都有大量参与的青少年在一年的随访期内犯罪活动的减少幅度明显大于对照组青少年，但物质使用的减少幅度较小。我们的研究结果支持，检查多个系统参与类别在临床上是有用的。治疗提供者可以利用这些结果确定他们的客户是否在所有系统中都有大量参与，并据此调整他们的方法。此外，研究人员可以继续剖析涉及多个系统的青少年在治疗轨迹上的差异以及影响这些差异的各种因素。
