1. Extending Mental Health Care as a Strategy to Reduce DMC Salome Raheim, Ph.D., ACSW Director & Associate Professor School of Social Work The University of Iowa

2. Reproduction of these materials only by author's explicit permission. Objectives Examine the link between mental health needs and youth offending behaviors Identify mental health access issues for minority youth and their families Discuss strategies to increase minority youth mental health access pre- and post- JJS involvement

3. Reproduction of these materials only by author's explicit permission. Mental Health  Youth Offending Youth mental health issues often go unrecognized. Minority mental health issues are more frequently unrecognized. Youth with mental health issues often exhibit “internalizing” and “externalizing” behaviors. (Huizinga & Jakob-Chien, 1998)

4. Reproduction of these materials only by author's explicit permission. Mental Health  Youth Offending Internalizing behaviors: –Anxiety –Depression –Behaviors reflecting low self-esteem and self-worth

5. Reproduction of these materials only by author's explicit permission. Mental Health  Youth Offending Externalizing behavior (masking behavior): –Aggression –Violence –Substance abuse –Sexual inappropriate behavior –Other socially unacceptable (acting out) behavior

6. Reproduction of these materials only by author's explicit permission. Mental Health  Youth Offending Masking behaviors lead to involvement with JJS. Without proper assessment, masking behaviors become the focus of intervention. Underlying issues may go untreated.

7. Reproduction of these materials only by author's explicit permission. Mental Health &Youth Offending Behaviors Mental health issues Externalizing behaviors Community response JJS MHS Assessment & Tx No Assessment & Tx

8. Reproduction of these materials only by author's explicit permission. Mental Health Access for Minority Youth & Families Less access to, and availability of, mental health services Less likely to receive needed mental health services In treatment often receive a poorer quality of mental health care Underrepresented in mental health research (Surgeon General,U.S. Department of Health and Human Services, 2001)

9. Reproduction of these materials only by author's explicit permission. Unique Mental Health Issues for Minority Youth and Families Social factors that negatively impact mental health – Social and economic inequality Exposure to racism & discrimination Greater exposure to violence Greater exposure to poverty (Surgeon General,U.S. Department of Health and Human Services, 2001)

10. Reproduction of these materials only by author's explicit permission. Population Specific Issues African Americans: Need – equal rate if in the community, greater if homeless, or in foster care Availability –“safety net providers” Access – ~25% uninsured Utilization – primary care, emergency room, psy. hospitals due to delay Outcomes – more diagnostic errors

11. Reproduction of these materials only by author's explicit permission. Population Specific Issues American Indians/Native Americans Need – disproportionate mental health problems Availability –limited by rural isolation; fewer youth specialists in rural communities Access – 20% uninsured Utilization – more traditional healing Outcomes – limited research

12. Reproduction of these materials only by author's explicit permission. Population Specific Issues Latino Americans Need – higher rates of depressive and anxiety symptoms for youth born in U.S. Availability –limited language appropriate services Access – 37% uninsured (2 x rate for whites) Utilization – more likely to use primary care Outcomes – limited research

13. Reproduction of these materials only by author's explicit permission. Population Specific Issues Asian Americans Need – equal; refugees higher PTSD risk Availability – limited language appropriate services Access – ~21% uninsured Utilization – lower rates; high severity; ethnic matching increases uses of services Outcomes – limited research

14. Reproduction of these materials only by author's explicit permission. Extending Mental Health Care Reducing disparities Increasing mental health service pre- JJS contact Integrating mental health services post- JJS contact