Publications by authors named "Matthew C Aalsma"

80 Publications

Do adolescents consider mind-body skills groups an acceptable treatment for depression: results from a pilot study.

BMC Pediatr 2021 Oct 27;21(1):475. Epub 2021 Oct 27.

Department of Psychology, Indiana University-Purdue University Indianapolis, 402 N. Blackford Street, LD 120B, Indianapolis, IN, 46202, USA.

Background: Mind-Body Skills Groups (MBSGs) have shown promise in reducing adolescent depression symptoms; however, little is known about adolescents' perspectives on this treatment. The objective of this study was to understand the acceptability of a new treatment for depressed adolescents in primary care settings.

Methods: Adolescents participating in a 10-week MBSG treatment were interviewed to understand their perspectives on the acceptability and effectiveness of the treatment. Interviews were collected at post-intervention and at a 3-month follow-up visit.

Results: A total of 39 adolescents completed both the post-intervention and 3-month follow-up interview. At post-intervention and follow-up, 84% of adolescents stated the MBSGs helped them. When asked how the MBSGs helped them, 3 areas were identified: learning new MBSG activities and skills, social connection with others within the group, and outcomes related to the group. Many adolescents reported no concerns with the MBSGs (49% at post- intervention; 62% at follow-up). Those with concerns identified certain activities as not being useful, wanting the group to be longer, and the time of group (after school) being inconvenient. Most adolescents reported that their life had changed because of the group (72% at post-intervention; 61% at follow-up), and when asked how, common responses included feeling less isolated and more hopeful.

Conclusions: Adolescents found the MBSGs to be helpful and acceptable as a treatment option for depression in primary care. Given the strong emphasis on treatment preference autonomy and the social activities within the group, MBSGs appear well-suited for this age group.

Trial Registration: NCT03363750 ; December 6th, 2017.
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http://dx.doi.org/10.1186/s12887-021-02942-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8549145PMC
October 2021

The point of diminishing returns in juvenile probation: Probation requirements and risk of technical probation violations among first-time probation-involved youth.

Psychol Public Policy Law 2021 May;72(2):283-291

Adolescent Behavioral Health Research Program, Department of Pediatrics, Section of Adolescent Medicine, Indianapolis, IN.

Technical probation violations are common among probation-involved youth, and across many jurisdictions, may result in detention or residential placement. The current study examined prevalence of technical violations occurring during one's probation period, the average time to technical violation, and individual-level and justice-related factors related to technical violations among probation-involved youth in a juvenile justice system. We analyzed electronic criminal records of 18,289 probation-involved youth following their first arrest (68.7% male, 53.9% Black, age=15.2). Technical violation was defined as a violation resulting from a non-criminal incident. We examined effects of charge severity, probation conditions (e.g., electronic monitoring) and program referrals (e.g., mental health) on likelihood of technical violation utilizing survival analysis stratified by race. Across 18,289 youth, 15.3% received a technical violation during their first probation; Black youth violated more quickly compared to White youth (log-rank test <.001). In multivariate survival analyses, the hazard for time to technical violation was higher for Black youth compared to white youth (<.001), males (=.04), and younger youth (<.001). Youth assigned to more probation requirements violated more quickly. Electronic monitoring and education, mental health, and drug programs were associated with shorter time to violation, controlling for race, ethnicity, and charge severity. Black youth violate more quickly compared to White youth. Across all youth, assignment to more probation requirements increased risk of technical violation and shorter time to violation. Despite the benefit of probation interventions, system-level efforts are needed to help youth adhere to probation requirements and successfully complete probation.
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http://dx.doi.org/10.1037/law0000282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475969PMC
May 2021

Use of Project ECHO to promote evidence based care for justice involved adults with opioid use disorder.

Subst Abus 2021 Jul 20:1-8. Epub 2021 Jul 20.

Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, Indiana, USA.

People with opioid use disorders (OUDs) are at heightened risk for involvement with the criminal justice system. Growing evidence supports the safety and effectiveness of providing empirically supported treatments for OUD, such as medications for OUD (M-OUD), to people with criminal justice involvement including during incarceration or upon reentry into the community. However, several barriers limit availability and accessibility of these treatment options for people with OUDs, including a shortage of healthcare and justice professionals trained in how to implement them. This study evaluated a novel education program, the Indiana Jail OUD Treatment ECHO, designed to disseminate specialty knowledge and improve attitudes about providing M-OUD in justice settings. Through didactic presentations and case-based learning (10 bimonthly, 90-min sessions), a multidisciplinary panel of specialists interacted with a diverse group of community-based participants from healthcare, criminal justice, law enforcement, and related fields. Participants completed standardized surveys about OUD knowledge and attitudes about delivering M-OUD in correctional settings. Thematic analysis of case presentations was conducted. Among 43 participants with pre- and post-series evaluation data, knowledge about OUD increased and treatment was viewed as more practical after the ECHO series compared to before. Cases presented during the program typically involved complicated medical and psychiatric comorbidities, and recommendations addressed several themes including harm reduction, post-release supports, and integration of M-OUD and non-pharmacological interventions. Evaluation of future iterations of this innovative program should address attendance and provider behavior change as well as patient and community outcomes associated with ECHO participation.
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http://dx.doi.org/10.1080/08897077.2021.1941518DOI Listing
July 2021

Youth Involved in the Justice System: Emergency Department Screening and Health Promotion.

J Pediatr 2021 09 24;236:11-12. Epub 2021 May 24.

Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address:

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http://dx.doi.org/10.1016/j.jpeds.2021.05.048DOI Listing
September 2021

Alliances to disseminate addiction prevention and treatment (ADAPT): A statewide learning health system to reduce substance use among justice-involved youth in rural communities.

J Subst Abuse Treat 2021 09 16;128:108368. Epub 2021 Mar 16.

Department of Psychology - Adolescent Behavioral Health Research Program, Indiana University - Purdue University Indianapolis, Indianapolis, IN, United States of America.

Background: Youth in the justice system (YJS) are more likely than youth who have never been arrested to have mental health and substance use problems. However, a low percentage of YJS receive SUD services during their justice system involvement. The SUD care cascade can identify potential missed opportunities for treatment for YJS. Steps along the continuum of the cascade include identification of treatment need, referral to services, and treatment engagement. To address gaps in care for YJS, we will (1) implement a learning health system (LHS) to develop, or improve upon, alliances between juvenile justice (JJ) agencies and community mental health centers (CMHC) and (2) present local cascade data during continuous quality improvement cycles within the LHS alliances.

Methods/design: ADAPT is a hybrid Type II effectiveness implementation trial. We will collaborate with JJ and CMHCs in eight Indiana counties. Application of the EPIS (exploration, preparation, implementation, and sustainment) framework will guide the implementation of the LHS alliances. The study team will review local cascade data quarterly with the alliances to identify gaps along the continuum. The study will collect self-report survey measures longitudinally at each site regarding readiness for change, implementation climate, organizational leadership, and program sustainability. The study will use the Stages of Implementation Completion (SIC) tool to assess the process of implementation across interventions. Additionally, the study team will conduct focus groups and qualitative interviews with JJ and CMHC personnel across the intervention period to assess for impact.

Discussion: Findings have the potential to increase SUD need identification, referral to services, and treatment for YJS.
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http://dx.doi.org/10.1016/j.jsat.2021.108368DOI Listing
September 2021

The Importance of Longitudinal Treatment Engagement for Youths in the Juvenile Justice System.

JAMA Pediatr 2021 Jul 6;175(7):e205820. Epub 2021 Jul 6.

Adolescent Behavioral Health Research Program, Department of Psychiatry, Indiana University School of Medicine, Indianapolis.

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http://dx.doi.org/10.1001/jamapediatrics.2020.5820DOI Listing
July 2021

How can healthcare professionals provide guidance and support to parents of adolescents? Results from a primary care-based study.

BMC Health Serv Res 2021 Mar 20;21(1):253. Epub 2021 Mar 20.

Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Suite 2025, Indianapolis, IN, 46202, USA.

Background: This study explored the rewards and difficulties of raising an adolescent and investigated parents' level of interest in receiving guidance from healthcare providers on parenting and adolescent health topics. Additionally, this study investigated whether parents were interested in parenting programs in primary care and explored methods in which parents want to receive guidance.

Methods: Parents of adolescents (ages 12-18) who attended an outpatient pediatric clinic with their adolescent were contacted by telephone and completed a short telephone survey. Parents were asked open-ended questions regarding the rewards and difficulties of parenting and rated how important it was to receive guidance from a healthcare provider on certain parenting and health topics. Additionally, parents reported their level of interest in a parenting program in primary care and rated how they would like to receive guidance.

Results: Our final sample included 104 parents, 87% of whom were interested in a parenting program within primary care. A variety of parenting rewards and difficulties were associated with raising an adolescent. From the list of parenting topics, communication was rated very important to receive guidance on (65%), followed by conflict management (50%). Of health topics, parents were primarily interested in receiving guidance on sex (77%), mental health (75%), and alcohol and drugs (74%). Parents in the study wanted to receive guidance from a pediatrician or through written literature.

Conclusions: The current study finds that parents identify several rewarding and difficult aspects associated with raising an adolescent and are open to receiving guidance on a range of parenting topics in a variety of formats through primary care settings. Incorporating such education into healthcare visits could improve parents' knowledge. Healthcare providers are encouraged to consider how best to provide parenting support during this important developmental time period.
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http://dx.doi.org/10.1186/s12913-021-06200-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981794PMC
March 2021

Development and examination of the attribution questionnaire-substance use disorder (AQ-SUD) to measure public stigma towards adolescents experiencing substance use disorders.

Drug Alcohol Depend 2021 04 13;221:108600. Epub 2021 Feb 13.

Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA.

Background: Public stigma may significantly impact adolescents with substance use disorders (SUDs), leading to limited treatment accessibility and utilization. However, few measures have been validated to assess public SUD stigma towards adolescents. In this study we developed the Attribution Questionnaire-Substance Use Disorder (AQ-SUD) by modifying the Attribution Questionnaire, a commonly used measure of public mental illness stigma. We examined 1) the psychometric properties of the AQ-SUD with supporting data from other stigma scales and 2) preliminary data on adults' perceptions of public stigma toward adolescents with SUDs.

Methods: Adult participants (n = 304) were randomly assigned to one of four vignettes about an adolescent with a specific SUD diagnosis (opioid, marijuana, alcohol, and stimulant use disorders). Participants completed the AQ-SUD and three other measures of public stigma designed to assess convergent and divergent validity.

Results: Analyses indicated that the modified AQ-SUD has good psychometric properties, and revealed a four-factor structure: negative emotions, assessment of responsibility, social disengagement, and lack of empathy. Additional public stigma scales demonstrated good psychometrics and provided evidence of both convergent and divergent validity for the AQ-SUD. Preliminary analysis of public stigma towards adolescents with a SUD suggests that attitudes about marijuana use disorder differ significantly from attitudes about other SUDs.

Conclusions: This study is the first to modify and validate a measure designed to assess perceptions of public SUD stigma towards adolescents, the AQ-SUD. Preliminary analyses suggest that adults view adolescent marijuana use disorders as less severe compared to other SUDs, which may have implications for adults' motivation to support youth in seeking treatment.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.108600DOI Listing
April 2021

Opioid Use Disorder Stigma, Discrimination, and Policy Attitudes in a National Sample of U.S. Young Adults.

J Adolesc Health 2021 08 10;69(2):321-328. Epub 2021 Feb 10.

Adolescent Behavioral Health Research Program, Indiana University, School of Medicine, Indianapolis, Indiana.

Purpose: A small fraction of people with opioid use disorder (OUD) receives appropriate care. Public opinion about addiction contributes to the availability and accessibility of effective treatment services. Little is known about such attitudes toward OUD among young adults, a population at heightened risk for OUD onset. The current study examined endorsement of social stigma, discrimination, and policy attitudes about OUD and hypothesized correlates of such attitudes (familiarity with OUD, criminal justice involvement, respondent demographic characteristics).

Methods: A national sample of 190 young adults (weighted n = 408; 69% female, 42% White, non-Hispanic) aged 19-29 years completed web and telephone surveys covering opioid social stigma, discrimination, policy attitudes, personal experience with opioids, and criminal justice, and participant characteristics (age, sex, race, education, employment, income). Linear regressions were performed to examine associations between respondent characteristics and attitudes.

Results: Young adults, on average, endorsed moderate levels of stigma and discrimination toward people with OUD and support for treatment-oriented policies. Stigma was positively associated with discrimination and negatively associated with support for policies favorable to people with OUD. Regression results revealed that more negative attitudes toward OUD were endorsed as a function of older age and less personal experience or familiarity with OUD.

Conclusions: Heterogeneity in young adults' attitudes about OUD may be explained, in part, by personal characteristics and familiarity with OUD. Adolescence may be an opportune developmental period to prevent or reduce public stigma related to OUD and MOUD and increase public attitudes in support of expanded access to effective OUD treatments.
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http://dx.doi.org/10.1016/j.jadohealth.2020.12.142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8316251PMC
August 2021

Two-year prevalence rates of mental health and substance use disorder diagnoses among repeat arrestees.

Health Justice 2021 Jan 7;9(1). Epub 2021 Jan 7.

Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.

Background: Individuals with mental illness and co-occurring substance use disorders often rapidly cycle through the justice system with multiple arrests. Therefore, is it imperative to examine the prevalence of mental health and substance use diagnoses among arrestees and repeat arrestees to identify opportunities for intervention.

Methods: We linked police arrest and clinical care data at the individual level to conduct a retrospective cohort study of all individuals arrested in 2016 in Indianapolis, Indiana. We classified arrestees into three levels: 1 arrest, 2 arrests, or 3 or more arrests. We included data on clinical diagnoses between January 1, 2014 and December 31, 2015 and classified mental health diagnoses and substance use disorder (SUD) based on DSM categories using ICD9/10 diagnoses codes.

Results: Of those arrested in 2016, 18,236 (79.5%) were arrested once, 3167 (13.8%) were arrested twice, and 1536 (6.7%) were arrested three or more times. In the 2 years before the arrest, nearly one-third (31.3%) of arrestees had a mental health diagnosis, and over a quarter (27.7%) of arrestees had an SUD diagnosis. Most of those with a mental health or SUD diagnosis had both (22.5% of all arrestees). Arrestees with multiple mental health (OR 2.68, 95% CI 2.23, 3.23), SUD diagnoses (OR 1.59, 95% CI 1.38, 1,82), or co-occurring conditions (1.72, 95% CI 1.48, 2.01) in the preceding 2 years had higher odds of repeat arrest.

Conclusions: Our findings show that linked clinical and criminal justice data systems identify individuals at risk of repeat arrest and inform opportunities for interventions aimed at low-level offenders with behavioral health needs.
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http://dx.doi.org/10.1186/s40352-020-00126-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7789256PMC
January 2021

Treatment of Adolescent e-Cigarette Use: Limitations of Existing Nicotine Use Disorder Treatment and Future Directions for e-Cigarette Use Cessation.

J Am Acad Child Adolesc Psychiatry 2021 01;60(1):14-16

Indiana University School of Medicine, Indianapolis.

Electronic cigarette use ("vaping") has surged in the United States since the mid-2010s. From 2011 to 2018, current e-cigarette use among high school students escalated from 1.5% to 20.8% (∼3.05 million youths), countering downward trends in combustible nicotine product use (21.8% in 2011 to 13.9% in 2018). Although preventing the initial uptake of vaping is crucial, for the millions of adolescents who have taken up this behavior-many of whom express interest in quitting (eg, 44.5% of current, adolescent non-light e-cigarette users in one US national representative sample)-it is critically important to help them quit vaping so as to curtail future substance use disorders and other health consequences. Here, we discuss several challenges around adolescent vaping treatment, and highlight research areas in urgent need of attention.
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http://dx.doi.org/10.1016/j.jaac.2020.07.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7977626PMC
January 2021

Patterns of drug screen results and court-ordered substance use treatment referrals and completion among justice-involved youth.

J Subst Abuse Treat 2020 11 4;118:108095. Epub 2020 Aug 4.

Adolescent Behavioral Health Research Program, Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America.

Background: Substance use is prevalent among justice-involved youth and given the risk of recidivism and other poor outcomes associated with substance use, justice systems have implemented efforts to improve substance use screening and connection to treatment. Although many justice systems use drug screening to monitor substance use, research on patterns of substance use based on drug screen records is lacking. The current study examined court records of drug screens among youth to explore patterns of substance use as well as rates of court-ordered referral to substance use treatment and treatment completion. We also examined differences in these patterns of use and treatment referral and completion by race, ethnicity, and gender.

Method: We examined court records for N = 3440 youth with records of positive oral drug screen (ODS) between 2011 and 2016 to assess patterns of ODS results (e.g., number and of positive screens), court-ordered referrals to substance use treatment, and rates of treatment completion.

Results: Of 3440 youth with a positive ODS, 96% tested positive for cannabis and 9.8% for opioids at least once; 48.5% were court-ordered to substance use treatment. Of those referred, 67% had history of completing at least one treatment episode; black youth (OR = 0.54, p < .01) were less likely to have history of completing substance use treatment.

Conclusion: Our results underscore the need to utilize objective measures as well as validated self-reports of substance use history in both research and justice system decision-making to aid in identifying youth in need of services. Additional research should identify barriers to substance use treatment completion among this population.
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http://dx.doi.org/10.1016/j.jsat.2020.108095DOI Listing
November 2020

Mind-Body Skills Groups for Adolescents With Depression in Primary Care: A Pilot Study.

J Pediatr Health Care 2020 Sep - Oct;34(5):462-469

Introduction: The objective of this study was to determine the acceptability and preliminary effectiveness of Mind-Body Skills Groups (MBSGs) as a treatment for depressed adolescents in primary care.

Method: A single-arm clinical trial was conducted. A 10-week MBSG program was implemented in primary care. Participants completed self-report measures at baseline, postintervention, and 3 months following the MBSGs. Measures included the Children's Depression Inventory-2, Suicidal Ideation Questionnaire, Mindful Attention Awareness Scale, Self-Efficacy for Depressed Adolescents, rumination subscale of the Children's Response Style Questionnaire, and a short acceptability questionnaire.

Results: Participants included 43 adolescents. The total depression scores significantly improved following the MBSG intervention and continued to improve significantly from posttreatment to follow-up. Mindfulness, self-efficacy, rumination, and suicidal ideation all had significant improvement following the intervention. Acceptability of the program was strong, and attendance was excellent.

Discussion: Preliminary evidence suggests that MBSGs are an acceptable treatment for primary care settings and lead to improved depression symptoms in adolescents.
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http://dx.doi.org/10.1016/j.pedhc.2020.05.003DOI Listing
September 2021

Patterns of adolescent gun carrying and gun-related crime arrests in Indianapolis, Indiana over an 11-year time period.

Prev Med 2020 10 9;139:106199. Epub 2020 Jul 9.

Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America.

Adolescent males are disproportionately affected by homicide as both victims and offenders. Indianapolis has seen increases in youth homicides over the past few years; gun carrying increases an individual's risk for involvement in firearm violence. It is unclear how often youth are arrested for gun carrying and gun-related crimes. Examining these patterns may identify an opportunity for intervention. This study is a descriptive epidemiology analysis that examines patterns of gun carrying and gun-related crime arrests among justice involved youth in Marion County (Indianapolis), Indiana. We accessed juvenile court records from January 1, 2006 to December 31, 2016 on all individuals arrested for a gun carrying offense (i.e., illegal possession of a firearm or gun; n = 711) and all individuals arrested for a gun-related crime (i.e., homicide, robbery, aggravated assault; n = 150). Data were analyzed in fall 2019. Proportions of juvenile arrests for both gun carrying (47.0 per 1000 arrests) and gun-related crime (25.4 per 1000 arrests) have substantially increased compared to ten-years ago (4.5 per 1000 arrests and 2.0 per 1000 arrests, respectively). Of those arrested, 27.7 per 100,000 population were arrested for a repeated gun-related offense; of which 21.5 per 100,000 were first arrested for gun carrying and 6.2 per 100,000 were arrested for a gun-related crime. The majority of gun-related repeat offenders were first arrested for gun carrying; therefore, these gun-carrying arrests may be an opportunity to intervene on an individual level by providing treatment, other needed resources, and discussing safe firearm storage with families and communities.
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http://dx.doi.org/10.1016/j.ypmed.2020.106199DOI Listing
October 2020

Patterns of adolescent gun carrying and gun-related crime arrests in Indianapolis, Indiana over an 11-year time period.

Prev Med 2020 10 9;139:106199. Epub 2020 Jul 9.

Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America.

Adolescent males are disproportionately affected by homicide as both victims and offenders. Indianapolis has seen increases in youth homicides over the past few years; gun carrying increases an individual's risk for involvement in firearm violence. It is unclear how often youth are arrested for gun carrying and gun-related crimes. Examining these patterns may identify an opportunity for intervention. This study is a descriptive epidemiology analysis that examines patterns of gun carrying and gun-related crime arrests among justice involved youth in Marion County (Indianapolis), Indiana. We accessed juvenile court records from January 1, 2006 to December 31, 2016 on all individuals arrested for a gun carrying offense (i.e., illegal possession of a firearm or gun; n = 711) and all individuals arrested for a gun-related crime (i.e., homicide, robbery, aggravated assault; n = 150). Data were analyzed in fall 2019. Proportions of juvenile arrests for both gun carrying (47.0 per 1000 arrests) and gun-related crime (25.4 per 1000 arrests) have substantially increased compared to ten-years ago (4.5 per 1000 arrests and 2.0 per 1000 arrests, respectively). Of those arrested, 27.7 per 100,000 population were arrested for a repeated gun-related offense; of which 21.5 per 100,000 were first arrested for gun carrying and 6.2 per 100,000 were arrested for a gun-related crime. The majority of gun-related repeat offenders were first arrested for gun carrying; therefore, these gun-carrying arrests may be an opportunity to intervene on an individual level by providing treatment, other needed resources, and discussing safe firearm storage with families and communities.
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http://dx.doi.org/10.1016/j.ypmed.2020.106199DOI Listing
October 2020

The Natural Course of Adolescent Depression Treatment in the Primary Care Setting.

J Pediatr Health Care 2020 Jan - Feb;34(1):38-46. Epub 2019 Sep 21.

Introduction: Little is known about how adolescents receive depression follow-up in primary care. The purpose of this study was to describe the rates of symptom assessment and depression treatment over time in a group of adolescents screening positive for moderate or severe depression in the primary care setting.

Methods: Retrospective chart reviews were conducted to gather information related to symptom reassessments, antidepressant prescriptions, psychotherapy referrals, and treatment discontinuation. Descriptive statistics were calculated, and a qualitative content analysis was conducted to determine the reasons for treatment discontinuation.

Results: Eighty records were reviewed (mean age = 15.3, 73% female, 59% Black). Treatment was initiated for 83% (n = 66) of patients, and 45% (n = 30) of patients discontinued treatment during the review period for a variety of reasons.

Discussion: To improve adolescents' adherence to depression treatment, providers should address factors that contribute to treatment discontinuation and use tools to manage depression follow-up care.
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http://dx.doi.org/10.1016/j.pedhc.2019.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6910991PMC
May 2021

Caregiver Comfort in Adolescents Independently Completing Screening Tablet-Based Questionnaires at Primary Care Visits.

J Adolesc Health 2019 12 12;65(6):799-804. Epub 2019 Sep 12.

Adolescent Behavioral Health Research Program, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana. Electronic address:

Purpose: The objective of this study was to assess caregiver comfort regarding adolescent completion of computerized health screening questionnaires created for adolescents.

Methods: We conducted a mixed-method, cross-sectional survey of caregivers of adolescent patients (n = 104) aged 12-18 years who had a medical visit between June 2017 and August 2017. Topics assessed included who completed the questionnaire, caregiver comfort and concern regarding questionnaire data, and caregiver reasons for involvement in completing the questionnaire. A one-way analysis of variance was used to compare the age of the adolescent and caregiver involvement in the questionnaire.

Results: The majority of adolescents (64%) reported independent completion of the questionnaire. Thirteen percent of caregivers completed the questionnaire with no involvement of the adolescent and 23% reported that caregivers and adolescents completed the questionnaire in tandem. The majority of caregivers (84%) were comfortable with adolescents completing the questionnaire. A variety of reasons were identified for caregivers completing the questionnaire (time constraints, 22%; adolescent requested caregiver help, 19%; caregiver desired to answer questions, 14%; caregiver did not realize that the questionnaire was intended for the adolescent, 11%; caregiver believed that the adolescent was too young to respond alone, 11%). Caregiver comfort with adolescent completing the questionnaire increase with age.

Conclusion: We found the reason most caregivers gave for completing the questionnaires were related to clinic processes (e.g. time constraints). Caregivers were more likely to complete the questionnaire with younger adolescents. Thus, pediatricians should consider how to best prepare families for initial questionnaires in primary care.
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http://dx.doi.org/10.1016/j.jadohealth.2019.07.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358079PMC
December 2019

The Importance of Connection and Context in Adolescent Violence.

Authors:
Matthew C Aalsma

JAMA Netw Open 2019 09 4;2(9):e1911374. Epub 2019 Sep 4.

Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis.

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http://dx.doi.org/10.1001/jamanetworkopen.2019.11374DOI Listing
September 2019

Implementing risk stratification to the treatment of adolescent substance use among youth involved in the juvenile justice system: protocol of a hybrid type I trial.

Addict Sci Clin Pract 2019 09 6;14(1):36. Epub 2019 Sep 6.

Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, USA.

Background: Youth involved in the juvenile justice system (YIJJ) have high rates of substance use problems; however, rates of YIJJ engagement in substance use services is low. Barriers to service engagement include lack of appropriate screening and connection to services by the juvenile justice system, as well as lack of resources for delivering evidence-based treatment in community-based settings. To address these barriers, this paper describes a protocol for a type 1 hybrid design to (1) implement universal substance use screening for YIJJ; (2) implement and evaluate the feasibility and effectiveness of a brief, three-session substance use interventions based in motivational interviewing for youth with mild/moderate substance use: Teen Intervene (an individual-based intervention); (3) implement ENCOMPASS, an evidence-based substance use intervention based in motivational enhancement and cognitive behavioral therapy for youth with severe substance use; and (4) evaluate facilitators and barriers to implementing these interventions for mild to severe substance use among YIJJ in community mental health centers (CMHC).

Methods/design: Using a hybrid type 1 clinical effectiveness-implementation design, we will collaborate with CMHCs and juvenile justice in two rural Indiana counties. Guided by the EPIS (exploration, preparation, implementation, sustainability) framework, we will measure factors that affect implementation of substance use screening in juvenile justice and implementation of substance use interventions in CMHCs utilizing self-reports and qualitative interviews with juvenile justice and CMHC staff pre- and post-implementation. YIJJ with mild/moderate substance use will receive a brief interventions and YIJJ with severe substance use will receive ENCOMPASS. We will measure the effectiveness of a brief and comprehensive intervention by assessing changes in substance use across treatment. We anticipate recruiting 160 YIJJ and their caregivers into the study. We will assess intervention outcomes utilizing baseline, 3-, and 6-month assessments.

Discussion: Findings have the potential to improve screening and intervention services for YIJJ.
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http://dx.doi.org/10.1186/s13722-019-0161-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729049PMC
September 2019

Applying an Electronic Health Records Data Quality Framework Across Service Sectors: A Case Study of Juvenile Justice System Data.

EGEMS (Wash DC) 2019 Jul 11;7(1):26. Epub 2019 Jul 11.

Indiana University School of Medicine, US.

Context: Integrating electronic health records (EHR) with other sources of administrative data is key to identifying factors affecting the long-term health of traditionally underserved populations, such as individuals involved in the justice system. Linking existing administrative data from multiple sources overcomes many of the limitations of traditional prospective studies of population health, but the linking process assumes high levels of data quality and consistency within administrative data. Studies of EHR, unlike other types of administrative data, have provided guidance to evaluate the utility of big data for population health research.

Case Description: Here, an established EHR data quality framework was applied to identify and describe the potential shortcomings of administrative juvenile justice system data collected by one of four case management systems (CMSs) across 12 counties in a Midwest state. The CMS data were reviewed for logical inconsistencies and compared along the data quality dimensions of plausibility and completeness.

Major Themes: After applying the data quality framework, several patterns of logical inconsistencies within the data were identified. To resolve these inconsistencies, recommendations regarding data entry, review, and extraction are offered.

Conclusion: The recommendations related to achieving quality justice system data can be applied to future efforts to link administrative databases from multiple sources. Increasing trust in administrative data quality related to vulnerable populations ultimately improves knowledge of pressing public health concerns.
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http://dx.doi.org/10.5334/egems.258DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6625535PMC
July 2019

Behavioral Health Service Utilization Among Detained Adolescents: A Meta-Analysis of Prevalence and Potential Moderators.

J Adolesc Health 2019 06;64(6):700-708

Department of Psychology, Purdue School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.

Purpose: Utilization of behavioral health treatment services among adolescents who have been detained or incarcerated within the juvenile justice system is poorly understood, with estimated utilization rates varying widely across studies. This meta-analysis was conducted to review and synthesize the literature on the prevalence of service utilization among this population.

Methods: Data from 27 studies of 28 distinct samples were abstracted and coded. A meta-analysis was conducted to calculate individual prevalence estimates of behavioral health service utilization, which were combined using random effects models. A moderator analysis was also conducted.

Results: Prevalence effect sizes (pr) for service utilization were low, with effect sizes pr = 33.1% for mental health services, pr = 27.95% for substance use-related services, and pr = 45.32% for unspecified services. The moderator analysis showed significant heterogeneity in prevalence of behavioral health service utilization.

Conclusions: The findings suggest limited service utilization by adolescents who had been detained or incarcerated, whether assessed before, during, or after confinement. Future research should focus on assessing the quality of, and youth access to, behavioral health services within and outside of juvenile justice facilities. Improved programs to ensure consistent treatment for previously detained or incarcerated adolescents are warranted.
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http://dx.doi.org/10.1016/j.jadohealth.2019.02.010DOI Listing
June 2019

Let Them Speak for Themselves: Improving Adolescent Self-Report Rate on Pre-Visit Screening.

Acad Pediatr 2019 07 25;19(5):581-588. Epub 2019 Apr 25.

Children's Health Services Research (RW Grout, ER Cheng, and SM Downs); Regenstrief Institute, Inc (RW Grout and SM Downs), Indianapolis.

Background: Adolescent pre-visit screening on patient-generated health data is a common and efficient practice to guide clinical decision making. However, proxy informants (eg, parents or caregivers) often complete these forms, which may lead to incorrect information or lack of confidentiality. Our objective was to improve the adolescent self-report rate on pre-visit screening.

Methods: We conducted an interventional study using an interrupted time series design to compare adolescent self-report rates (percent of adolescents ages 12-18 years completing their own pre-visit screening) over 16 months in general pediatric ambulatory clinics. We collected data using a computerized clinical decision support system with waiting room electronic tablet screening. Preintervention rates were low, and we created and implemented 2 electronic workflow alerts, one each to the patient/caregiver and clinical staff, reminding them that the adolescent should answer the questions independently. We included the first encounter from each adolescent and evaluated changes in adolescent self-reporting between pre- and postintervention periods using interrupted time series analysis.

Results: Patients or caregivers completed 2670 qualifying pre-visit screenings across 19 preintervention, 7 intervention, and 44 postintervention weeks. Self-reporting by younger adolescents nearly doubled, with a significant increase of 19.3 percentage points (confidence interval [CI], 9.1-29.5) from the baseline 20.5%. Among older adolescents, the stable baseline rate of 53.6% increased by 9.2 absolute percentage points (CI, -7.0 to 25.3). There were no significant pre- or postintervention secular trends.

Conclusions: Two automated alerts directing clinic personnel and families to have adolescents self-report significantly and sustainably improved younger adolescent self-reporting on electronic patient-generated health data instruments.
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http://dx.doi.org/10.1016/j.acap.2019.04.010DOI Listing
July 2019

The Role of Pregnancy Concerns in the Relationship between Substance Use and Unprotected Sex among Adolescents.

Subst Use Misuse 2019 8;54(7):1060-1066. Epub 2019 Apr 8.

a Department of Pediatrics, Section of Adolescent Medicine , Indiana University School of Medicine , Indianapolis , IN , USA.

Background: Substance use and unprotected sex are prevalent among adolescents. The link between substance use and unprotected sex is well-established. Research has also highlighted how adolescents' attitudes and risk perceptions regarding unprotected sex, including concerns about pregnancy ("Getting pregnant would force me to grow up too fast"), are associated with unprotected sex and unplanned pregnancy. However, less research has examined the potential relationship between pregnancy concerns and substance use among adolescents.

Objectives: The study prospectively examined (1) differences in pregnancy concerns across patterns of substance use and (2) whether pregnancy concerns mediate the relationship between substance use and later unprotected sex among a sample of middle and high school students.

Method: 98 adolescents [M(SD) age = 14.28(1.68), 59.4% female, 59.4% black/African American] completed self-report measures of marijuana and alcohol use, pregnancy concerns, and unprotected sex across three time points over 6 months (T1-T3).

Results: Substance users (alcohol/marijuana) reported fewer pregnancy concerns compared to non-substance users (t = 2.99, p = .04). Pregnancy concerns at T2 mediated the relationship between T1 lifetime substance use and later unprotected sex (T3) (indirect effect: b = 0.10, CI[.01-.41]; direct effect: b = 0.15, p = .32), controlling for gender, age, and race. More frequent substance use (T1) was related to fewer pregnancy concerns at T2 (b = -0.10, p = .04); fewer pregnancy concerns were related to increased likelihood of later unprotected sex (b = -1.02, p = .02).

Conclusions: Findings offer new insight into associations between substance use and unprotected sex and suggest that substance use and sexual health interventions should target pregnancy concerns.
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http://dx.doi.org/10.1080/10826084.2018.1524912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498425PMC
March 2020

Pubertal influences on neural activation during risky decision-making in youth with ADHD and disruptive behavior disorders.

Dev Cogn Neurosci 2019 04 7;36:100634. Epub 2019 Mar 7.

Adolescent Behavioral Health Research Program, Indiana University School of Medicine, Indianapolis, IN, United States; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States.

Objective: Risk-taking during adolescence is a leading cause of mortality; Neuroscience research examining pubertal effects on decision-making is needed to better inform interventions, particularly among youth with attention-deficit/hyperactivity (ADHD) and disruptive behavior disorders (DBD), who are particularly prone to risky decision-making. We examined effects of pubertal development on risky decision-making and neural activation during decision-making among youth with ADHD/DBDs.

Method: Forty-six 11-12-year-olds (29.4% girls; 54.9% white; Tanner M(SD) = 2.08(1.32)) who met DSM-5 criteria for ADHD/DBD completed the Balloon Analog Risk Task (BART) during fMRI scanning. We examined effects of Tanner stage, sex, and age on risky decision-making (mean wager at which individuals stopped balloon inflation) and neural activation in the middle frontal gyrus and the ventral striatum during the choice and outcome phases of decision-making.

Results: Those in earlier pubertal stages made riskier decisions during the BART compared to those in later Tanner stages (β=-0.62, p =  .02). Later pubertal stage was associated with greater activation in the left middle frontal gyrus (β=0.61, p = .03) during the choice phase and in the right ventral striatum in response to rewards (β=0.59, p = .03).

Conclusion: Youth with ADHD/DBD in later stages of puberty, regardless of age, show greater ventral striatal activation in response to rewards.
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http://dx.doi.org/10.1016/j.dcn.2019.100634DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6560631PMC
April 2019

: How Latina Adolescents Experience, Self-Manage, and Seek Treatment for Depressive Symptoms.

Qual Health Res 2019 10 27;29(12):1725-1738. Epub 2019 Feb 27.

Indiana University School of Nursing, Indianapolis, Indiana, USA.

Latina (female) adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than their non-Latina White peers. We aimed to develop a framework that explains how Latina adolescents experience, self-manage, and seek treatment for depressive symptoms. Latina young women ( = 25, age = 16.8 years) who experienced depressive symptoms during adolescence were recruited from clinical and community settings and interviewed about experiences with depressive symptoms. The framework was developed using constructivist grounded theory methods. Participants experienced a psychosocial problem that we labeled . They responded to this problem through a five-phase psychosocial process that we labeled . Family members, peer groups, and mainstream authorities were influential in how participants experienced these phases. Future research should further develop this framework in diverse samples of Latino/a youth. Clinicians can use this framework in discussions with Latina adolescents about depressive symptoms.
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http://dx.doi.org/10.1177/1049732319831043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935425PMC
October 2019

Poly-use of cannabis and other substances among juvenile-justice involved youth: variations in psychological and substance-related problems by typology.

Am J Drug Alcohol Abuse 2019 8;45(3):313-322. Epub 2019 Jan 8.

a Department of Psychology , Indiana University-Purdue University , Indianapolis , IN , USA.

Background: Adolescent cannabis use is associated with increased risk for psychological problems, with evidence for more severe problems among youth who use cannabis in combination with other substances (i.e., polysubstance use). Juvenile offenders engage in both cannabis use and polysubstance use at higher rates than the general adolescent population. Yet, limited research has examined the relationship between cannabis poly-use (e.g., cannabis and alcohol use) and functional or psychological problems among juvenile offenders.

Objectives: The current study addresses this gap by examining the association of polysubstance use of cannabis compared to cannabis only use with cognitive functioning, psychological distress, and substance-related problems among juvenile detainees.

Methods: Participants were 238 detained youth ages 12-18 (80.4 % male, 77.3% non-White) who completed assessments of substance use, intellectual functioning, psychological symptoms, and substance-related problems. Youth were also assessed by a clinical psychologist for substance use disorder.

Results: Four cannabis-use typologies were identified; cannabis and alcohol use was the largest class, followed by cannabis only use, cannabis, alcohol and other drug use, then cannabis and other drug use. Polysubstance use was associated with lower scores on measures of intellectual functioning, more externalizing and internalizing symptomology, and more substance-related problems relative to cannabis only use. However, the relationship between polysubstance use and problems varied by typology.

Conclusions: Findings suggest that justice-involved youth engaged in polysubstance use may be at greater need for concurrent academic, affective, and behavioral support in their rehabilitation and transition back to the community.
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http://dx.doi.org/10.1080/00952990.2018.1558450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6450756PMC
May 2020

Medicaid Coverage and Continuity for Juvenile Justice-Involved Youth.

J Correct Health Care 2019 01 7;25(1):45-54. Epub 2019 Jan 7.

5 Division of Adolescent Medicine, Adolescent Behavioral Health Research Program, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.

This study examined Medicaid coverage and continuity for youth with varying levels of justice system involvement and the impact of a policy change allowing Medicaid suspension, rather than termination. Data for this study were collected using a retrospective cohort design using arrest records and Medicaid enrollment tables for 20,688 youth. Age, gender, race/ethnicity, and deepest level of justice system involvement all were associated with time to de-enrollment from Medicaid. Suspension was associated with a small improvement in Medicaid continuity for justice-involved youth. In addition, youth with deeper levels of justice system involvement had faster time to de-enrollment. This study highlights the importance of maximizing opportunities to keep youth enrolled, as gaps in coverage will likely affect juveniles' access to physical, mental, and behavioral health care.
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http://dx.doi.org/10.1177/1078345818820043DOI Listing
January 2019

Substance use disorder and posttraumatic stress disorder symptomology on behavioral outcomes among juvenile justice youth.

Am J Addict 2019 01 21;28(1):29-35. Epub 2018 Dec 21.

Department of Psychology, Indiana University-Purdue University, Indianapolis, Indiana.

Background And Objectives: Substance use behaviors have been identified as a risk factor that places juveniles at greater risk for engaging in delinquent behaviors and continual contact with the juvenile justice system. Currently, there is lack of research that explores comorbid factors associated with substance use, such as post-traumatic stress disorder (PTSD) symptoms, that could help identify youth who are at greatest risk. The aim of the present study was to examine if PTSD symptomology moderated the relationship between substance use disorder (SUD) symptoms and externalizing behaviors and commission of a violent crime; hypothesizing that risk would be heightened among youth with elevated SUD and PTSD symptomology compared to those with elevated SUD symptoms but lower PTSD symptoms.

Method: The study included 194 predominantly male (78.4%), non-White (74.2%) juvenile justice youth between the ages of 9-18 (M = 15.36). Youth provided responses to assess PTSD symptoms, SUD symptoms, and externalizing behaviors. Commission of a violent crime was based on parole officer report.

Results: Findings indicated that SUD symptomology was associated with greater externalizing behaviors at high levels of PTSD symptomology. At low levels of PTSD symptomology, SUD symptoms were inversely associated with externalizing behaviors. An interactive relationship was not observed for commission of violent crimes.

Conclusions: Findings suggest that the association between SUD symptoms and externalizing behaviors among juvenile offenders may be best explained by the presence of PTSD symptomology.

Scientific Significance: Addressing PTSD rather than SUD symptoms may be a better target for reducing risk for externalizing behaviors among this population of youth (Am J Addict 2019;28:29-35).
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http://dx.doi.org/10.1111/ajad.12831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6640645PMC
January 2019

Identifying and Managing Developmental and Behavioral Health Concerns within Primary Care: A Push for Change.

J Pediatr 2019 03 15;206:9-12. Epub 2018 Nov 15.

Department of Pediatrics Division of Adolescent Medicine Indiana University School of Medicine Indianapolis, Indiana.

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http://dx.doi.org/10.1016/j.jpeds.2018.10.052DOI Listing
March 2019

Burnout and Mental Health Stigma Among Juvenile Probation Officers: The Moderating Effect of Participatory Atmosphere.

Adm Policy Ment Health 2019 03;46(2):167-174

Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.

Despite high rates of mental health problems among juvenile justice-involved youth, mental health stigma among juvenile probation officers (JPOs) is under-studied. This cross-sectional study examined effects of job burnout and workplace participatory atmosphere on mental health stigma among JPOs across Indiana (n = 226). Participatory atmosphere moderated the relationship between JPO burnout-related cynicism and mental health stigma (interaction β = - 0.14, p = .04); burnout was related to greater mental health stigma at low levels of participatory atmosphere. Findings suggest participatory atmosphere mitigates effects of burnout on mental health stigma among JPOs. Organizational-level interventions might help to reduce mental health stigma and combat negative effects from burnout among JPOs.
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http://dx.doi.org/10.1007/s10488-018-0902-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374158PMC
March 2019
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