Untitled

Abstract

This paper posits that providers with training in and knowledge of mental health resources are more likely to recognize youths' mental health problems, and provide youths with services. In 1994 and 1996, we interviewed 792 adolescents who were involved with St. Louis public health, juvenile justice, child welfare. or education service sectors. Two hundred eighty-two youths had received some services, listing 533 providers. We could identify 364 of those providers, and 61% (222) responded concerning service need, service use, and provider knowledge and behavior. Structural equation models demonstrate that provider assessment of youths' mental health problems is the largest and provider knowledge of service resources the second largest determinant of service provision. Youths' self-reported mental health is not positively associated with increased services and is only minimally associated with provider assessment of their problems. Training (both professional and inservice) contributes to higher assessments of youths' problems and greater resource knowledge, which is associated with increased service provision. Providers from the mental health and child welfare sectors have more professional training in mental health and are more likely to receive inservice training. Inservice training should be offered to all who work with youths.

Juvenile Probation Officers’ Mental Health Decision Making

“…Considering those already receiving services at case opening, and those with newly identified service needs, altogether almost 40% of delinquent youths were identified as having service needs. This stands in contrast to the overall rate of only 15% elsewhere identified by gateway providers (Stiffman et al 2000) across multiple service sectors. This suggests that, somewhat consistent with the known levels of mental health and substance use problems of the population they serve, probation staff may be more likely to decide that youths in their care have mental health concerns than are the other types of gateway providers studied by Stiffman (Stiffman et al 2004: school, health, and child welfare staff).…”

“…In common with Stiffman et al (2000Stiffman et al ( , 2004, we find aspects of gatekeeper mental health competence to be related to identification of mental health needs for youths on their caseloads. The role of mental health competence has been similarly highlighted for other mental health gatekeepers, such as pediatricians (Leaf et al 2004), suggesting that specialized training in mental health may be an effective way to increase identification and service linkage.…”

“…Although these are proxy comparisons, they indicate that probation staff are far more likely to identify externalizing problems (or to be informed about externalizing reasons for treatment for youths already receiving mental health services) than they are to identify or be informed about internalizing problems. Similarly low identification rates by gatekeepers occur in other service sectors; for example, physicians and primary healthcare providers fail to recognize more than half of existing mental health problems (Stiffman et al 2000). Medical providers in an HMO referred fewer than half of adolescents with a documented Substance Use Disorder to either substance abuse or mental health treatment (Scott et al 2004).…”

“…A recent examination of referral decision-making (Stiffman et al 2004) considers characteristics of the youth, gatekeeper and organizational context as they contribute to gateway providers' referral or recommendation for services in a large sample of adolescents (Stiffman et al 2000). The authors use ''gateway provider'' rather than ''gatekeeper'', but the terms refer to similar activities.…”

“…The authors use ''gateway provider'' rather than ''gatekeeper'', but the terms refer to similar activities. Gateway providers may be friends, family members, or nonspecialty providers, whose understanding of the youth's difficulties is essential to their recommending or suggesting services (Stiffman et al 2000). Nonspecialty providers, in particular, may have an initial service contact, identify a problem, provide some immediate services and then refer on to specialty mental health services.…”