Made in America: Perspectives on Friendship in West African Immigrant Families

This qualitative study compared West African immigrant parents’ and adolescents’ perspectives on parental monitoring of adolescents’ peer groups. Parents (n = 31) and adolescent children (n = 25) were interviewed using focus groups and individual interviews, and data were analyzed using a grounded theory approach. Parents expressed a general concern about external influences on their children, particularly their mistrust of their children’s friends. Adolescents reported that they were aware of their parents’ fears and described their attempts to manage their parents’ concerns while simultaneously maintaining friendships with same-ethnic and other-ethnic peers. This study offers both parent and adolescent perspectives in an effort to better understand adolescents’ peer socialization and parental monitoring among West African immigrant families, one of the fastest growing demographic groups in the United States. Recommendations for mental health professions are discussed.     

Adolescent mental health in Japan and Russia: The role of body image,bullying victimisation and school environment

This study examined associations between self-reported mental health problems, body image, bullying victimisation and school safety in large adolescent samples in Japan and Russia, considering the effects of gender, culture and their interactions. In both Japan and Russia, girls reported a greater number of mental health problems, less bullying victimisation and much higher body dissatisfaction than boys did. Japanese adolescents rated themselves higher on total difficulties, reported less body dissatisfaction and bullying victimisation, and rated their school safety lower than that of Russian youths. Cross-cultural differences in total difficulties and body image were qualified by gender. Body dissatisfaction, bullying victimisation and school safety all independently contributed to adolescent mental health problems. The protective effect of school safety on total difficulties was larger for girls than for boys; the strength of the association between bullying victimisation and adolescent mental health problems differed across genders and cultures. The findings indicate a need for a cross-cultural approach and provide a strong basis for targeted interventions that seek to improve adolescent mental health.     

Pathways to Adolescent Substance Use Among Sexually Abused Girls

This study examined the link between childhood sexual abuse and adolescent substance use among girls, and evaluated depressive self-concept and behavioral under-control (BUC) as pathways to substance use for sexually abused girls. Participants (n = 150) were drawn from a longitudinal study of the impact of domestic violence on the lives of women and children. Structural equation modeling revealed that girls childhood sexual abuse was associated prospectively with their later substance use. This relationship persisted when age, co-occurring forms of child abuse (physical, exposure to domestic violence), childhood depression and aggression, family income, maternal substance use, and parenting practices were controlled. Behavioral under-control mediated the relationship between childhood sexual abuse and later substance use, but depressive self-concept did not. Implications, limitations, and directions for future research are discussed.     

Understanding Barriers to Initial Treatment Engagement among Underserved Families Seeking Mental Health Services

This mixed method study examined factors associated with parents not attending their child’s mental health treatment after initially seeking help for their 2–5 year old child. It was part of a larger study comparing two evidence-based treatments among low-income racial/ethnic minority families seeking child mental health services. Of 123 parents who initiated mental health treatment (71?% African American or multi-racial; 97.6?% low-income), 36 (29.3?%) never attended their child’s first treatment session. Socio-demographic characteristics, parenting stress, depression, severity of child behavior problems, and length of treatment delay from intake to first scheduled treatment session were compared for families who did and did not attend their first treatment session. Parents who never attended their child’s first treatment session were more likely to live with more than four adults and children (p?=?.007) and have more depressive symptoms (p?=?.003). Median length of treatment delay was 80 days (IQR?=?55) for those who attended and 85 days (IQR?=?67.5) for those who did not attend their child’s first treatment session (p?=?.142). Three themes emerged from caregiver interviews: (a) expectations about the treatment, (b) delays in getting help, and (c) ambivalence about research participation. Findings suggest the need to develop better strategies for addressing risk factors early in the treatment process and reducing the length of time families with adverse psychosocial circumstances must wait for child mental health treatment.     

Threats to Enabling Contexts: Exploring Adolescents' Experiences of Aggression

This article explores adolescents' experiences of aggression in a secondary, multi-cultural school context in South Africa. The study group comprised of boys (n=24) and girls (n=17), attending grades 8–12. An inductive qualitative research approach was chosen where participants wrote about their experiences and participated in focused semi-structured interviews. Central themes were derived by means of a thematic content analysis. The results revealed that adolescents experienced negative feelings about aggression at school and that aggression was related to individual characteristics, the adolescent developmental stage, socialization, status, competition, home environment, prior experiences, learnt behaviour and the effect of the media and music. Exposure to aggression had emotional consequences such as feelings of anger, fear, depression, being controlled and a loss of self-content. Behavioural responses included retaliation, pacifism, vandalism and suicide. The findings suggest that learner involvement, conflict resolution skills and school guidance are necessary to manage aggression in the secondary school context.     

Eating Disorders in an Israeli Women’s Prison: Correlates of the Risk

Extensive rates of child abuse and neglect (CAN), substance abuse disorders (SUDs), and mental health problems have been reported among incarcerated women. The link between CAN, SUDs, and eating disorders is well-documented, but little is known about the eating-disorder behaviors of incarcerated women. The purpose of this study was (a) to explore eating-disorder behaviors among incarcerated women in Israel; (b) to examine whether certain types of CAN are associated with eating disorders; and (c) to study the link between CAN, SUDs, mental health problems, and eating disorders. This cross-sectional study investigated eating-disorder behaviors in a sample of 62 incarcerated women in Israel. The findings indicated a high prevalence of eating disorders among incarcerated women; almost 70% exhibited the drive for thinness, which is considered a central feature of eating disorders. In addition, the findings revealed a high prevalence of CAN (84.2%), especially emotional abuse (57.9%) and emotional neglect (73.7%). I also found a high rate of co-occurrence of CAN, SUDs, mental health problems, and eating disorders. Bulimia nervosa, ineffectiveness, and low impulse regulation were found to be associated with SUDs and mental health problems (p?=?0.006, p?=?0.032, and p?<?0.001, respectively). The findings highlight the intersection of trauma with self-destructive behaviors, including co-occurrences of SUDs, eating disorders, and severe mental health problems as a result of negative childhood experiences, suggesting a need for simultaneous treatment interventions.     

Adolescent Girls and Their Mothers Talk About Experiences of Binge and Loss of Control Eating

Evidence suggests that adolescents’ experience of binge eating (BE) might differ in important ways from that of adults. Moreover, although BE appears more common in African American women than other disordered eating behaviors, little is known about the influence of cultural factors on this behavior in adolescents. The current investigation used qualitative methodology to examine the perceptions of White and African American adolescent girls and their mothers regarding experiences of binge and loss of control eating. Five focus groups were completed with 19 adolescent girls (aged 13–17, 58 % African American, 41 % White) who endorsed loss of control eating behaviors. Their mothers (N = 19) also completed separate, concurrent focus groups addressing food and eating behaviors. Responses to focus group questions were analyzed using thematic qualitative analysis. Adolescents’ awareness of their eating behaviors varied greatly. Girls reported some awareness of how emotions influence their eating behaviors, and described using food to achieve autonomy. Mothers evidenced awareness of their daughters’ problematic eating behaviors, the effects of emotions on eating for both their daughters and themselves, and sociocultural factors influencing diet. Data from these focus groups can inform the development of innovative interventions for adolescent girls engaging in loss of control eating.     

Systemic Family Therapy Competences in Child and Adolescent Mental Health Care

This article is based on a doctoral research project aiming to identify a comprehensive and detailed outline of the systemic therapist competences in child and adolescent mental health care in Norway. Because of the growing demands to offer specialized services within child and adolescent mental health care, I intended the identified competences to target the psychosocial difficulties that are categorized as associated abnormal psychosocial situations (axis 5) in the multiaxial diagnostic system (WHO, Multiaxial classification of child and adolescent psychiatric disorders. The ICD-10 classification of mental and behavioural disorders in children and adolescents. Cambridge University Press, Cambridge, 1996). The project is based on twelve qualitative in-depth interviews with six experienced systemic family therapists, and fieldwork observations of the therapists (participants) in practice. The qualitative methodology is based on Grounded Theory and five overarching categories were identified through the analysis: (1): the importance of ethical and contextual awareness in systemic therapy; (2) the systemic therapist’s stance; (3) therapeutic processes; (4) therapeutic practices; and (5) session-specific features. Challenges, such as limiting the systemic approach to five overarching competences, are discussed alongside this strengths and limitations of the study. The detailed outline of systemic therapist competences is intended to offer a framework for delivering flexible, yet specialized systemic therapy in the context of child and adolescent mental health care. This research may therefore facilitate a “bridge-building process” between mental health’s biomedical focus and postmodern systemic ideas.     

Mental health treatment need among pregnant and postpartum women/girls entering substance abuse treatment

Substance use during pregnancy is widely acknowledged as a major public health concern with detrimental effects on both mother and unborn child. Mental health issues often co-occur with substance use and may trigger continued use during pregnancy or relapse to use postpartum, though little is known about the extent of these issues in pregnant and postpartum women entering substance abuse treatment. The purpose of this study is: (a) to examine self-reported mental health in a population of women and girls who were pregnant in the past year and are entering substance abuse treatment, and (b) to determine whether disparity exists in mental health treatment received across groups by race and age if a treatment need is present. Secondary data analysis was conducted with Global Appraisal of Individual Needs (GAIN) data from 502 female adolescents and adults who reported having been pregnant in the past year and who completed the GAIN upon entry into substance abuse treatment. Participants were compared on demographic, diagnostic, and problem severity variables by race and age. Results indicate that mental health treatment need is high among the whole pregnant and postpartum sample, but African American and Hispanic women and girls are receiving less mental health treatment than other groups despite having a need for it. No mental health treatment acquisition disparity was found by age.     

Correlates of Victimization in a Juvenile Justice Population

The Practical Adolescent Dual Diagnostic Interview is a structured diagnostic interview designed to gather basic information about mental health conditions; past emotional, physical, and sexual abuse; suicide attempts; and substance use disorders. This instrument was administered to 435 males and 61 females in juvenile justice facilities and adolescent diversion courts to assess prevalence of mental health and substance use disorders relative to maltreatment (defined as physical, sexual, and/or emotional abuse). Results showed that the majority of juveniles who experienced maltreatment were more likely to have diagnostic indications of behavioral health conditions. Additionally, for both males and females the odds of the individual having attempted suicide were more than twice as high for those acknowledging some form of maltreatment.     

Utah youth suicide study: psychological autopsy

We conducted a psychological autopsy study to further understand youth suicide in Utah. While traditional psychological autopsy studies primarily focus on the administration of psychometric measures to identify any underlying diagnosis of mental illness for the suicide decedent, we focused our interviews to identify which contacts in the decedent's life recognized risk factors for suicidal behavior, symptoms of mental illness, as well as barriers to mental health treatment for the decedent. Parents and friends recognized most symptoms universally, although friends better recognized symptoms of substance abuse than any other contact. The study results suggest that parents and friends are the most appropriate individuals for gatekeeper training and, in conjunction with other innovative screening programs, may be an effective strategy in reducing adolescent suicide.     

The Interface between Mental Health Providers, Families, and Schools: Parent and Child Attitudes about Information-Sharing

Youth with emotional and behavioral disorders (EBD) are at an increased risk for school problems and negative consequences into adulthood, increasing the need for collaboration between families, school personnel and mental health providers. Current treatment guidelines emphasize the importance of information-sharing between providers and schools, yet few studies have addressed parents’ or students’ attitudes and preferences about this process or about the disclosure of mental health-related information to school professionals. Using a sample of 73 pairs of parents and their adolescents seeking outpatient treatment, this study assessed parental and adolescent attitudes about disclosure of mental health treatment information to school personnel. The majority of parents reported that the school should be informed that their adolescent was receiving counseling or medication for EBD, and that they should be the primary informant, rather than providers. By comparison, adolescents preferred more discretion about their involvement in treatment. Taken together, the study results highlight a number of implications relevant to the therapeutic relation and the process of obtaining and sharing mental health-related treatment information with various school personnel. Future research directions regarding the consultative and collaborative process with school personnel are also discussed.     

"CAN'T YOU SEE THE COURAGE, THE STRENGTH THAT I HAVE?"Listening to Urban Adolescent Girls Speak about Their Relationships

This study explored, qualitatively, the ways in which 12 urban, poor and working-class adolescent girls spoke about themselves, their relationships, and their school over a 3 year period. The ability to be outspoken or to "speak one's mind" in relationships was identified as the most prevalent theme in their interviews. Ten of the 12 adolescent girls indicated that they were able to speak openly and honestly in many of their relationships. These outspoken voices were focused not only on expressing anger and disagreement in relationships, but also on voicing care and connection. Seven of the adolescents indicated, however, that while they were outspoken in their relationships with parents, teachers, and female friends, they were not willing to "speak their minds" in their relationships with boys. These findings raise critical questions regarding the psychology of girls and women.     

Families in Crisis

Abstract

Families are in crisis. With an increasing array of problems affecting children in the home, from child abuse to familial alcoholism, schools are facing a vast array of behavioral and emotional concerns affecting childhood behavior. Unfortunately, many negative behaviors are learned at home. Violent and aggressive behaviors, for example, as well as drug and alcohol abuse, are often demonstrated by parents. From a community perspective, schools are in a pivotal position from which to intervene. Yet, many school-based mental health professionals, including school psychologists, school counselors, and school social workers, lack the knowledge to provide direct interventions. This article examines contemporary problems facing families, considers the home-school linkage, and explores interventions for schools and school-based mental health professionals.     

Psychological correlates of sexual abuse in adolescent girls in chemical dependency treatment

A study involving 597 adolescent girls in treatment for substance abuse between 1984 and 1986 at nine inpatient facilities in five states reveals a strikingly high prevalence of sexual abuse victimization. Over one-third (35.2%) of the girls acknowledged such a history. In an additional 9.7% of the cases, the primary counselor reported such a history for the patient, although she had denied it, at least at intake. Within this multiproblem, highly stressed population, the sexual abuse victim appears to show slightly different and often more serious psychopathology: a greater incidence of suicidal ideation and attempts, symptoms of agitation, and a sense of shame.     

Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre–post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous–unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents’ report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls’ mental health and family functioning in particular. The study’s results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.     

Relation of early menarche to depression, eating disorders, substance abuse, and comorbid psychopathology among adolescent girls

This prospective study tested whether early menarche partially accounts for the increases in depression, eating pathology, substance abuse, and comorbid psychopathology that occur among adolescent girls, with structured interview data from a community sample (N = 496). Early menarche (prior to 11.6 years) was associated with elevated depression, substance abuse, and "any" disorder but did not confer increased risk for anorexia nervosa, bulimia nervosa, or binge eating disorder. Although there was significant comorbidity across all three classes of pathology, early menarche was associated only with comorbid depression and substance abuse. Results provide partial support for the assertion that early menarche is a general risk factor for psychopathology among adolescent girls but suggest that this risk may not apply to certain disorders and that the effects are modest in size.     

Effects of diversion on adults with co-occurring mental illness and substance use: outcomes from a national multi-site study

This quasi-experimental non-equivalent comparison group study examines outcomes for participants in eight programs conducting criminal justice diversion for people with co-occurring serious mental illness and substance use disorders compared with jail detainees eligible for diversion, but who were processed through standard criminal justice methods without diversion. Nearly 2000 participants were interviewed at baseline, and 1500 at 3 month and 1300 at 12 month follow-up to baseline. In these interviews, outcome measures of re-arrest, mental health functioning, substance abuse, quality of life, and service utilization were obtained. Those diverted were more likely to have received mental health counseling, mental health medication, and mental health hospitalization than those not enrolled in a diversion program, but were equally likely to have received substance abuse counseling. Overall, the differences in proportions receiving services between the two groups were small, even when these differences were statistically significant. The effect associated with diversion differed somewhat across the individual sites. However, overall cross-site pooled analyses revealed no outcome differences between groups on measures of mental health symptoms, substance use, criminal justice recidivism, or quality of life. Although the immediate benefit of diversion as an access mechanism to community treatment is indicated in pooled cross-site results, such access was driven by more coercive (pre-booking and court) models and results suggest that effecting substantially greater access to services or services use did not occur. The findings also suggest that mental health, substance abuse, and criminal justice outcomes remain dependent on the treatment intervention received, perhaps moderated by type of diversion intervention, rather than on a generic and initial diversion event.     

Reward sensitivity and substance abuse in middle school and high school students

In this study, the authors investigated the relation between reward and punishment sensitivity and adolescent substance use. The sample (N = 216; 130 girls, 85 boys) was drawn from high school and middle school students enrolled in a Midwestern suburban school district. Participants completed a substance use questionnaire and the Sensitivity to Punishment and Sensitivity to Reward Questionnaire (R. Torrubia, C. Avila, J. Molto, & X. Caseras, 2001). For 13 of 15 types of substance abuse, students with high reward sensitivity and low punishment sensitivity showed the highest levels of use. This finding supports the hypothesis of an interaction effect between reward sensitivity and punishment sensitivity and suggests that individuals who are high in reward sensitivity but low in sensitivity to punishment may be at a higher risk for substance abuse.     

Episodic emotions of Tshivenda cultural community mothers towards their adolescent children’s pregnancies

This study explored Tshivenda mothers’ emotional reactions to the learning of unplanned pregnancies of their adolescent daughters. Ten purposively selected mothers with early parent adolescent children were informants (age range = 40 to 55 years). They responded to semi-structured face-to-face interviews on their reactions to the learning of the pregnancies of their daughters. The interview data were thematically analysed. Findings suggest the mothers experienced anger and embarrassment, objective and subjective burdens supporting their early parent daughter, and fears for the health of their mother-to-be daughters. The mothers reported to cope with pregnancy of their daughters by religion supplication, acceptance and social support, as well as open communication with their adolescent daughters about the pregnancies.