- Email: [email protected]
161. Predictors Of Recidivism Among Juvenile Detainees: The Impact Of Mental Health Screening And Court-Ordered Counseling
S90
Poster Abstracts / 50 (2012) S16 –S95
found on websites. Eight measures were disease-specific: cystic fibrosis (n⫽2), liver disease/transplant (n⫽2), spina bifida (n⫽1), and sickle cell disease (n⫽2). Most measures assessed knowledge (35/38; 92%) and skills/self-efficacy (34/38; 89%). Few covered SMART preexisting components and the intervenable components of beliefs/ expectations, goals, and psychosocial/emotions. Conclusions: Limitations of current transition readiness measures include lack of psychometric data, focus on patient disease knowledge and skills, and lack of demonstrated predictive validity, thus limiting understanding of the ability of the measure to relate to clinical outcomes after transfer. In addition, no measures include patient, parent, and provider versions to assess discrepancies and agreements related to perceived patient transition readiness of all stakeholders. The development of new theoretically informed, multiinformant, and validated transition readiness measures are needed to inform transition readiness planning and program development from a social-ecological and systems perspective. Sources of Support: R21 CA141332.
SESSION II: JUVENILE JUSTICE 160.
by SHB only and SHB⫹SA indicated cutting as the most frequent method endorsed (36.4% SHB vs. 76.0% SHB ⫹SA, ?2 ⫽ 17.96, p ⬍ .001). Multiple methods of SHB were significantly associated with SA. More than three types of SHB occurred in 44% of adolescents who attempted suicide. Conclusions: Detained Taiwanese adolescents who endorsed multiple methods of SHB were at risk for SA because over time, SHB became more frequent and severe. Risk of depression was highly associated with SA. It is important to identify and help these adolescents while detained, since health care staffs, counselors and psychiatrists are available for intervention and treatment. Studies showed that an attempted suicide may lead to a completed suicide later on. Any intervention that leads to a reduction in the rate and methods of SHB and treatment of depression may prevent future suicide attempts. Sources of Support: FEMH. 161. PREDICTORS OF RECIDIVISM AMONG JUVENILE DETAINEES: THE IMPACT OF MENTAL HEALTH SCREENING AND COURT-ORDERED COUNSELING James Dolittle, MS, Matthew Aalsma, PhD. Indiana University
SELF-HARMING BEHAVIOR AND DEPRESSION AS RISK FACTORS FOR SUICIDE ATTEMPTS AMONG DETAINED TAIWANESE ADOLESCENTS Mei HuaTsai, MD. Far Eastern Memorial Hospital Purpose: Some studies show that adolescents who self-harm have no apparent intention to kill themselves, and that they endorse selfharming behavior (SHB) to resist the urges to attempt suicide. On the contrary, several studies show SHB is related to suicide attempts (SA). Prevalence rate of SHB in relation to SA among community-based youths in the United States of America (U.S.) is 15.9% SHB and 5.6% SA. In Canada and Germany, the rate is 15% and 25.6% SHB, while it is 4% and 6.5% for SA respectively. In Taiwan, the rate is 22.4% SHB and 2.2% SA. On the other hand, the prevalence rates of SHB and SA in detention centers in the U.S. have increased to 30% SHB and 32% SA. Depression had been implicated in SA among adolescents. This study aims to investigate the relationship among multiple types of SHB, depression and SA among detained youths. Methods: A total of 1,189 adolescents were detained in 2010. Twenty three percent participated in this study. Their age ranged from 13 to 21 years old. The survey included SHB checklists, depression screening questionnaires (CES-D), and SA assessments. SHB checklists included intentional cutting, burning, carving, biting, banging, severe scratching and preventing wounds from healing. The cutting point of CESD was higher than 23 for males and 26 for females as the depression risk group. The suicide item used was: “I tried method of suicide but did not succeed.” Chi-square was conducted to investigate the characteristics of the respondents and analysis of self-harm outcomes. Results: The final sample consisted of 209 males (76.3%) and 65 females (23.7%), with a mean age of 16.3 years. Of the 274 youths surveyed, 141 (51.5%) denied self-harm (NoSH), 17(6.2%) admitted SA, 66 (24.1%) engaged in SHB, and 50 (18.2%) endorsed SHB ⫹ SA. The prevalence rate of SHB was 42.3% and SA was 24.5%. The female gender was significantly associated with SA, whether SA alone (12.3% female vs. 4.3% male), or SHB ⫹ SA (40% female vs. 11.5% male, ( X2 ⫽ 35.96, p ⬍.0001). Another was the CES-D score, such that a higher than cut-off score resulted in SA (X2 ⫽ 31.69, p ⬍.001). Methods used
Purpose: A considerable percentage of juvenile offenders suffer from mental illness and substance use disorders. Undiagnosed mental illness increases the chance that a youth will reoffend. Research has shown that screening for mental health disorders and providing treatment programs for juvenile offenders reduces. Research has also shown that juvenile incarceration rates are negatively related to the utilization of public mental health services. Further investigation is needed, however, to study how linkages to care during and following detention impact recidivism. As part of a broader research project assessing access to mental and physical health care by youth detained in a large, Midwestern detention center, we seek to describe how the implementation of a mental health screening program has affected youth’s access to mental health services and, ultimately, how these services have impacted their chances of reoffending. Methods: Electronic juvenile court records, medical, and claims data for youths released from detention between April 2004 and March 2008 were accessed. Mental health screening (measured by the Massachusetts Youth Screening Instrument-Second Version) had been implemented at the midpoint of this four-year period. We analyzed each youth’s first detention during the study period. Recidivism data was gathered at three month and sixth months. Logistic regression was used to determine the impact of race, gender, mental health screening, and court-ordered home-based counseling have on being re-detained or reoffending with a felony, misdemeanor, status offense, or probation violation. Results: Among 8,085 youth, 24.6% (1988) reoffended three months following disposition and 35.8% (2892) reoffended six months after disposition. Further analysis of six-month recidivism rates reveals that 10.8% (877) committed a felony, 11.8% (954) committed a misdemeanor, 6% (482) committed a status offense, 0.5% (37) violated probation, and 6.7% (538) had warrants issued. The results from the logistic regression indicate that: (1) African-American youth (as opposed to White) are 1.41 times more likely to reoffend within six months, (t ⫽ 6.59, p ⬍ .001); (2) male youth are 1.33 times more likely to reoffend within six months, (t ⫽ 4.93, p ⬍ .001); youth who were screened for mental health disorders during detention are 1.34 times more likely to reoffend within six months, (t ⫽ 5.58, p ⬍ .001), and; (4) youth who were ordered to receive home-based counseling are
Poster Abstracts / 50 (2012) S16 –S95
1.52 times more likely to reoffend within six months, (t ⫽ 5.07, p ⬍ .001). The results are similar when looking at the likelihood of being detained again within six months. Conclusions: We found that court-ordered mental health was related to recidivism. However, the fact that a judge ordered homebased counseling does not mean that the youth and her or his family participated or that the services were effective. Additionally, the presence of screening and mental health services does not automatically lead to improved recidivism. Both the severity of the mental illness and the effectiveness of the home-based services must be considered when evaluating their impact on recidivism. There is evidence to support that race and gender impact risk of reoffending. Sources of Support: HRSA/MCHB R40MC08721; HRSA/MCHB T7100008. 162. INTERNET ACCESS AND ATTITUDES TOWARD ONLINE PERSONAL HEALTH INFORMATION AMONG DETAINED YOUTH Greg Gaskin, BS1, Arash Anoshiravani, MD, MPH2. 1
Stanford University 2Santa Clara County Juvenile Institutions/Stanford School of Medicine Purpose: To both characterize Internet access among a sample of justice-involved youth and survey their attitudes toward accessing their personal health information (PHI) online. Methods: Purposeful sampling was used to identify seventy-nine participants within a large, Northern California juvenile detention facility. Detained youth were interviewed, using a semi-structured interview format about the following themes: internet access and usage patterns outside of detention; types of personal health information they would find useful upon reentry into the community; and interest in accessing and sharing PHI using a secure, online tool. Both the Stanford University and Santa Clara Valley Medical Center IRBs approved the protocol. All participants provided in-person assent (consent if 18 yrs) and at least one parent provided witnessed telephone consent. Results: The mean age of the study participants was 17.2 years, with a range from 13-18 years. Both the ethnic and gender breakdown (17% Caucasian, 55% Hispanic, 9% AfricanAmerican, 7% Asian or Pacific Islander, and 3% other; 84% percent male, respectively) were consistent with the overall demographics of the studied juvenile detention facility. Nearly all participants reported high levels of Internet access and usage with over 97% describing using the Internet at least once per month and 87% reported using the Internet at least weekly. Ninety percent of participants expressed interest in accessing their own personal health information through a secure, online system. Of those interested in online access to PHI, they were most interested in being able to access a record of their immunizations (99%), their current medication list (92%), and their sexually transmitted infection screening results (80%). While only 44% of interested participants wanted to share PHI with their community-based health care provider, over half (52%) stated they would be interested in sharing health information with their parents or other family members. Conclusions: Detained youth have remarkably high levels of access to the internet outside of the custody setting, and they are interested in accessing and sharing their health information online. These results suggest that providing detained youth secure, online access to their PHI may help to address some of their health information needs upon reentry to the community.
S91
Sources of Support: None. 163. THEIR VOICES: DISCOVERING THE PRIMARY HEALTH CONCERNS OF UNDERSERVED ADOLESCENT GIRLS IN THE SANTA CLARA COUNTY JUVENILE DETENTION CENTER Mikaela A. Kelly, BA1, Arash Anoshiravani, MD, MPH2. 1
Stanford University 2Santa Clara Valley Medical Center
Purpose: To understand the primary health concerns and health perceptions of adolescent girls in a large, predominantly urban countyrun juvenile custody institution in order to inform future interventions aimed at improving their health knowledge and health outcomes. Methods: This exploratory qualitative study utilized individual, semi-structured interviews with 30 detained girls aged 14 to 18 years from a predominantly Latino population. Investigators electronically recorded and transcribed all interviews and used grounded theory for thematic analysis using NVIVO software. Study participants provided in-person assent (consent if 18 years or older), and parents provided witnessed consent by telephone. Recruitment stopped once thematic saturation was reached. Results: Preliminary analyses have identified sexual and reproductive health issues as the predominant concerns of detained girls. Three main themes emerged: 1) poor sexual/reproductive health understanding due to poor school attendance; 2) sporadic or nonexistent dialogue with trusted adults around sexual health issues; and 3) influential and often manipulative sexual partners who encouraged high-risk sexual behaviors, including condom and contraception avoidance. Conclusions: Poor health education, lack of communication with trusted adults, and the influence of sexual partners all contribute to the high-risk sexual behaviors and high prevalence of pregnancy and STIs among detained young women documented in the literature. Detention may provide an important intervention opportunity aimed at improving health understanding and increasing communication and decision-making confidence for this population of young women who often have profound histories of physical, emotional, and sexual trauma. Sources of Support: N/A.
SESSION II: HIV 164. DETERMINANTS OF HIV SEROSTATUS SELF-DISCLOSURE AMONG ADOLESCENTS PARTICIPATING IN THE ADOLESCENT IMPACT STUDY Yolanda L. Peele, MEd1, Lawrence J. D’Angelo, MD, MPH1, Sulachni Chandwani, MD2, Susan Abramowitz, PhD2, Linda Koenig, PhD3. 1
Children’s National Medical Center 2New York University School of Medicine 3Centers for Disease Control and Prevention Purpose: Self-disclosure of positive HIV status can provide adolescents with support from family, friends, and sexual partners. It can also increase stigma, discrimination and rejection for the HIV-positive adolescent and his/her family. This study sought to examine the prevalence and predictors of self-disclosure in HIVpositive adolescents. Methods: Data were collected at baseline assessment from participants enrolled in Adolescent Impact, an intervention study of risk
Poster Abstracts / 50 (2012) S16 –S95
found on websites. Eight measures were disease-specific: cystic fibrosis (n⫽2), liver disease/transplant (n⫽2), spina bifida (n⫽1), and sickle cell disease (n⫽2). Most measures assessed knowledge (35/38; 92%) and skills/self-efficacy (34/38; 89%). Few covered SMART preexisting components and the intervenable components of beliefs/ expectations, goals, and psychosocial/emotions. Conclusions: Limitations of current transition readiness measures include lack of psychometric data, focus on patient disease knowledge and skills, and lack of demonstrated predictive validity, thus limiting understanding of the ability of the measure to relate to clinical outcomes after transfer. In addition, no measures include patient, parent, and provider versions to assess discrepancies and agreements related to perceived patient transition readiness of all stakeholders. The development of new theoretically informed, multiinformant, and validated transition readiness measures are needed to inform transition readiness planning and program development from a social-ecological and systems perspective. Sources of Support: R21 CA141332.
SESSION II: JUVENILE JUSTICE 160.
by SHB only and SHB⫹SA indicated cutting as the most frequent method endorsed (36.4% SHB vs. 76.0% SHB ⫹SA, ?2 ⫽ 17.96, p ⬍ .001). Multiple methods of SHB were significantly associated with SA. More than three types of SHB occurred in 44% of adolescents who attempted suicide. Conclusions: Detained Taiwanese adolescents who endorsed multiple methods of SHB were at risk for SA because over time, SHB became more frequent and severe. Risk of depression was highly associated with SA. It is important to identify and help these adolescents while detained, since health care staffs, counselors and psychiatrists are available for intervention and treatment. Studies showed that an attempted suicide may lead to a completed suicide later on. Any intervention that leads to a reduction in the rate and methods of SHB and treatment of depression may prevent future suicide attempts. Sources of Support: FEMH. 161. PREDICTORS OF RECIDIVISM AMONG JUVENILE DETAINEES: THE IMPACT OF MENTAL HEALTH SCREENING AND COURT-ORDERED COUNSELING James Dolittle, MS, Matthew Aalsma, PhD. Indiana University
SELF-HARMING BEHAVIOR AND DEPRESSION AS RISK FACTORS FOR SUICIDE ATTEMPTS AMONG DETAINED TAIWANESE ADOLESCENTS Mei HuaTsai, MD. Far Eastern Memorial Hospital Purpose: Some studies show that adolescents who self-harm have no apparent intention to kill themselves, and that they endorse selfharming behavior (SHB) to resist the urges to attempt suicide. On the contrary, several studies show SHB is related to suicide attempts (SA). Prevalence rate of SHB in relation to SA among community-based youths in the United States of America (U.S.) is 15.9% SHB and 5.6% SA. In Canada and Germany, the rate is 15% and 25.6% SHB, while it is 4% and 6.5% for SA respectively. In Taiwan, the rate is 22.4% SHB and 2.2% SA. On the other hand, the prevalence rates of SHB and SA in detention centers in the U.S. have increased to 30% SHB and 32% SA. Depression had been implicated in SA among adolescents. This study aims to investigate the relationship among multiple types of SHB, depression and SA among detained youths. Methods: A total of 1,189 adolescents were detained in 2010. Twenty three percent participated in this study. Their age ranged from 13 to 21 years old. The survey included SHB checklists, depression screening questionnaires (CES-D), and SA assessments. SHB checklists included intentional cutting, burning, carving, biting, banging, severe scratching and preventing wounds from healing. The cutting point of CESD was higher than 23 for males and 26 for females as the depression risk group. The suicide item used was: “I tried method of suicide but did not succeed.” Chi-square was conducted to investigate the characteristics of the respondents and analysis of self-harm outcomes. Results: The final sample consisted of 209 males (76.3%) and 65 females (23.7%), with a mean age of 16.3 years. Of the 274 youths surveyed, 141 (51.5%) denied self-harm (NoSH), 17(6.2%) admitted SA, 66 (24.1%) engaged in SHB, and 50 (18.2%) endorsed SHB ⫹ SA. The prevalence rate of SHB was 42.3% and SA was 24.5%. The female gender was significantly associated with SA, whether SA alone (12.3% female vs. 4.3% male), or SHB ⫹ SA (40% female vs. 11.5% male, ( X2 ⫽ 35.96, p ⬍.0001). Another was the CES-D score, such that a higher than cut-off score resulted in SA (X2 ⫽ 31.69, p ⬍.001). Methods used
Purpose: A considerable percentage of juvenile offenders suffer from mental illness and substance use disorders. Undiagnosed mental illness increases the chance that a youth will reoffend. Research has shown that screening for mental health disorders and providing treatment programs for juvenile offenders reduces. Research has also shown that juvenile incarceration rates are negatively related to the utilization of public mental health services. Further investigation is needed, however, to study how linkages to care during and following detention impact recidivism. As part of a broader research project assessing access to mental and physical health care by youth detained in a large, Midwestern detention center, we seek to describe how the implementation of a mental health screening program has affected youth’s access to mental health services and, ultimately, how these services have impacted their chances of reoffending. Methods: Electronic juvenile court records, medical, and claims data for youths released from detention between April 2004 and March 2008 were accessed. Mental health screening (measured by the Massachusetts Youth Screening Instrument-Second Version) had been implemented at the midpoint of this four-year period. We analyzed each youth’s first detention during the study period. Recidivism data was gathered at three month and sixth months. Logistic regression was used to determine the impact of race, gender, mental health screening, and court-ordered home-based counseling have on being re-detained or reoffending with a felony, misdemeanor, status offense, or probation violation. Results: Among 8,085 youth, 24.6% (1988) reoffended three months following disposition and 35.8% (2892) reoffended six months after disposition. Further analysis of six-month recidivism rates reveals that 10.8% (877) committed a felony, 11.8% (954) committed a misdemeanor, 6% (482) committed a status offense, 0.5% (37) violated probation, and 6.7% (538) had warrants issued. The results from the logistic regression indicate that: (1) African-American youth (as opposed to White) are 1.41 times more likely to reoffend within six months, (t ⫽ 6.59, p ⬍ .001); (2) male youth are 1.33 times more likely to reoffend within six months, (t ⫽ 4.93, p ⬍ .001); youth who were screened for mental health disorders during detention are 1.34 times more likely to reoffend within six months, (t ⫽ 5.58, p ⬍ .001), and; (4) youth who were ordered to receive home-based counseling are
Poster Abstracts / 50 (2012) S16 –S95
1.52 times more likely to reoffend within six months, (t ⫽ 5.07, p ⬍ .001). The results are similar when looking at the likelihood of being detained again within six months. Conclusions: We found that court-ordered mental health was related to recidivism. However, the fact that a judge ordered homebased counseling does not mean that the youth and her or his family participated or that the services were effective. Additionally, the presence of screening and mental health services does not automatically lead to improved recidivism. Both the severity of the mental illness and the effectiveness of the home-based services must be considered when evaluating their impact on recidivism. There is evidence to support that race and gender impact risk of reoffending. Sources of Support: HRSA/MCHB R40MC08721; HRSA/MCHB T7100008. 162. INTERNET ACCESS AND ATTITUDES TOWARD ONLINE PERSONAL HEALTH INFORMATION AMONG DETAINED YOUTH Greg Gaskin, BS1, Arash Anoshiravani, MD, MPH2. 1
Stanford University 2Santa Clara County Juvenile Institutions/Stanford School of Medicine Purpose: To both characterize Internet access among a sample of justice-involved youth and survey their attitudes toward accessing their personal health information (PHI) online. Methods: Purposeful sampling was used to identify seventy-nine participants within a large, Northern California juvenile detention facility. Detained youth were interviewed, using a semi-structured interview format about the following themes: internet access and usage patterns outside of detention; types of personal health information they would find useful upon reentry into the community; and interest in accessing and sharing PHI using a secure, online tool. Both the Stanford University and Santa Clara Valley Medical Center IRBs approved the protocol. All participants provided in-person assent (consent if 18 yrs) and at least one parent provided witnessed telephone consent. Results: The mean age of the study participants was 17.2 years, with a range from 13-18 years. Both the ethnic and gender breakdown (17% Caucasian, 55% Hispanic, 9% AfricanAmerican, 7% Asian or Pacific Islander, and 3% other; 84% percent male, respectively) were consistent with the overall demographics of the studied juvenile detention facility. Nearly all participants reported high levels of Internet access and usage with over 97% describing using the Internet at least once per month and 87% reported using the Internet at least weekly. Ninety percent of participants expressed interest in accessing their own personal health information through a secure, online system. Of those interested in online access to PHI, they were most interested in being able to access a record of their immunizations (99%), their current medication list (92%), and their sexually transmitted infection screening results (80%). While only 44% of interested participants wanted to share PHI with their community-based health care provider, over half (52%) stated they would be interested in sharing health information with their parents or other family members. Conclusions: Detained youth have remarkably high levels of access to the internet outside of the custody setting, and they are interested in accessing and sharing their health information online. These results suggest that providing detained youth secure, online access to their PHI may help to address some of their health information needs upon reentry to the community.
S91
Sources of Support: None. 163. THEIR VOICES: DISCOVERING THE PRIMARY HEALTH CONCERNS OF UNDERSERVED ADOLESCENT GIRLS IN THE SANTA CLARA COUNTY JUVENILE DETENTION CENTER Mikaela A. Kelly, BA1, Arash Anoshiravani, MD, MPH2. 1
Stanford University 2Santa Clara Valley Medical Center
Purpose: To understand the primary health concerns and health perceptions of adolescent girls in a large, predominantly urban countyrun juvenile custody institution in order to inform future interventions aimed at improving their health knowledge and health outcomes. Methods: This exploratory qualitative study utilized individual, semi-structured interviews with 30 detained girls aged 14 to 18 years from a predominantly Latino population. Investigators electronically recorded and transcribed all interviews and used grounded theory for thematic analysis using NVIVO software. Study participants provided in-person assent (consent if 18 years or older), and parents provided witnessed consent by telephone. Recruitment stopped once thematic saturation was reached. Results: Preliminary analyses have identified sexual and reproductive health issues as the predominant concerns of detained girls. Three main themes emerged: 1) poor sexual/reproductive health understanding due to poor school attendance; 2) sporadic or nonexistent dialogue with trusted adults around sexual health issues; and 3) influential and often manipulative sexual partners who encouraged high-risk sexual behaviors, including condom and contraception avoidance. Conclusions: Poor health education, lack of communication with trusted adults, and the influence of sexual partners all contribute to the high-risk sexual behaviors and high prevalence of pregnancy and STIs among detained young women documented in the literature. Detention may provide an important intervention opportunity aimed at improving health understanding and increasing communication and decision-making confidence for this population of young women who often have profound histories of physical, emotional, and sexual trauma. Sources of Support: N/A.
SESSION II: HIV 164. DETERMINANTS OF HIV SEROSTATUS SELF-DISCLOSURE AMONG ADOLESCENTS PARTICIPATING IN THE ADOLESCENT IMPACT STUDY Yolanda L. Peele, MEd1, Lawrence J. D’Angelo, MD, MPH1, Sulachni Chandwani, MD2, Susan Abramowitz, PhD2, Linda Koenig, PhD3. 1
Children’s National Medical Center 2New York University School of Medicine 3Centers for Disease Control and Prevention Purpose: Self-disclosure of positive HIV status can provide adolescents with support from family, friends, and sexual partners. It can also increase stigma, discrimination and rejection for the HIV-positive adolescent and his/her family. This study sought to examine the prevalence and predictors of self-disclosure in HIVpositive adolescents. Methods: Data were collected at baseline assessment from participants enrolled in Adolescent Impact, an intervention study of risk