Minoritized youth have lower prevalence rates of substance use disorders (SUD) compared with White peers, but proportionally those that are diagnosed are less likely to engage in specialized care and there are few culturally responsive treatments or programs available. We examine social determinants of SUD, with emphasis on the impact of trauma, including racial trauma, and include an intersectional approach incorporating race, ethnicity, and gender. This review of the literature highlights evidence-based effective clinical practice as examples for the field in developing therapeutic approaches to SUD for this population.

This practice update considers adolescent stalking. Adolescent stalking is an area of research that deserves further study given findings from the adult stalking literature that suggest significant public health and legal consequences associated with these behaviors. However, very little is known about this phenomenon, its potential differentiation from adolescent dating violence and/or bullying and directions to take for future research. A comprehensive review across 5 scientific databases yielded a total of 9 peer-reviewed manuscripts incorporating varying sample sizes and adolescent populations. A synthesis of existing research suggests that adolescent stalking exists at levels at least as high as that documented among adults but appears to have some notable differences (e.g., behavioral patterns, risk factors) from stalking behaviors among adults. To date, there exists no published representative population-based study of adolescent stalking behaviors and its health and legal consequences. Future research is needed to determine accurate prevalence statistics and to differentiate characteristics and public health impact of adolescent stalking from dating violence and/or bullying.

The term justice-involved youth encompasses a broad range of youth. It can include youth who have not been detained and have been placed on probation or diversion programs, as well re-entry populations transitioning out of detention facilities or stated custody and placed on probation or parole. There are more than 1.3 million juvenile arrests per year, and on any given day there are 50,821 youth incarcerated in the United States. Of the 716,000 delinquency cases, probation is court-ordered for approximately half.¹ Even among these youth who are supervised in the community, rates of mental health and substance use disorders are high, with more than two-thirds reporting substance use problems or other mental health disorders.² However, these youth often have a hard time connecting to and staying in treatment,³ and recidivism is high-most commonly for failing to satisfy the myriad (and well intentioned) conditions of their probation.⁴ Dual diagnosis (ie, co-occurring psychiatric and substance use disorders) in justice-involved youth is one of the most significant predictors of recidivism,⁵ and, as such, closing the gap between need and receipt of substance use and mental health treatment for justice-involved youth could potentially offset rates of re-offending into adulthood.⁶ Despite high rates of mental health and substance use disorders among justice-involved adolescents, only 15% of detained youth receive mental health treatment for their condition(s); this number falls to 8% once these youth re-enter the community.⁷ These statistics regarding treatment receipt among justice-involved youth are important to consider not only from a health care perspective but also in terms of public health significance and policy.

This study surveyed malingering prevalence in pretrial homicide defendants and assessed the usefulness of the Mini-Mental State Examination (MMSE) and the Rey 15-Item Memory Test (FIT) in detecting malingering among them. Malingering prevalence was 17%. MMSE and FIT scores were positively correlated. The MMSE and FIT had modest positive predictive value (67% and 43%), but reasonably good negative predictive value (93% and 89%), for malingering. Overall, the MMSE outperformed the FIT, with no advantage to combined use of the MMSE and FIT over the MMSE. The widely used MMSE, traditionally a bedside test of cognition, may have a role in malingering assessment.

BACKGROUND: Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families. OBJECTIVE: This study aims to understand child welfare system professionals perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement. METHODS: This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework. RESULTS: Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68%), White individuals (n=10, 53%), and social workers (n=8, 42%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy. CONCLUSIONS: Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin.

Objective

While previous studies have identified relationships between school truancy and adolescent substance use risk, sexual risk remains unaddressed.

Methods

Urban early adolescents (mean age, 13.14 years) with mental health symptoms completed audio computer-assisted self-interviews regarding risk behaviors.

Results

Teens who reported a history of skipping school (n = 25), compared with those who did not (n = 113), indicated greater frequency of having ever engaged in oral, vaginal, and anal sex, as well as nonintercourse sexual behaviors. They also reported less value in remaining abstinent but did not demonstrate differences in HIV knowledge or school connectedness.

Conclusion

Truancy may serve as an important marker for the early identification of youth at risk for unintended pregnancy or sexually transmitted diseases.

Co-design of digital mental health technology with youth and families is a relatively new but growing approach to intervention development. In this perspective article, researchers used collaborative reflexivity through duoethnography methodology to reflect and report on experiences and lessons learned conducting co-designed projects with marginalized youth and families. Researchers engaged in written reflective dialogue regarding projects designed to co-develop technology-based apps and computer programs to support mental health of youth and their families. Reflections described the barriers and challenges for sharing responsibilities with stakeholders who have extensive lived experience but limited exposure to research. Researchers shared insights about their own intersectionality and positionality from marginalized to privileged, relative to co-design participants, and what it means to share authority, authentic partnership, and responsibility in the research process. Cultural understanding may diverge, even between acculturated minority researchers and matched minority stakeholders. While there are a variety of approaches that researchers might refer to as co-design, it is important to be intentional in the implementation of these processes so that collaborations with stakeholder youth and families are neither disingenuous nor exploitative. Implications for equitable and meaningful engagement of marginalized communities in co-design projects for youth mental health are discussed.

Little is known about which first-time offending truant youth re-offend, especially in comparison to youth with first-time delinquent offenses. The purpose of this study was to compare rates and risk factors for recidivism between youth with first-time truancy offenses and delinquent offenses. All youth included in this study were referred for forensic mental health evaluation due to mental health concerns. Findings revealed that rates of 12-month recidivism were comparable and both groups were more likely to commit a future delinquent offense than a truancy or status offense. Risk for recidivism among truant youth was higher for those with an externalizing disorder and those who witnessed domestic violence. Within truant recidivists, being male and having a history of substance use increased likelihood of future delinquency. Study findings suggest that universal screening for truant youth upon court contact is justified and may be useful for selecting targeted recidivism prevention and intervention efforts. This may be particularly important for truant youth with mental health concerns, as indicated by the sample used in this study.

We examined whether pre-existing parent psychological distress moderated juvenile offenders substance use, sexual risk, and mental health outcomes in a randomized trial. Forty-seven parent-adolescent dyads received either Family-based Affect Management Intervention (FAMI) for adolescent substance use and HIV prevention or adolescent-only Health Promotion Intervention (HPI). Parents self-reported distress at baseline significantly moderated adolescents self-reported marijuana use and alcohol use but not other outcomes at 3 months postintervention, producing crossover interactions. FAMI outperformed HPI when parents reported high-level distress, whereas HPI outperformed FAMI when parents reported low-level distress. This finding that the relative efficacy of interventions depends on the severity of parent psychological distress could inform efforts to match substance-using, justice-involved adolescents with the intervention most likely to benefit them.

Justice-involved youth have a number of risk factors for HIV infection, including high rates of substance use, psychiatric comorbidities, and risky sexual behaviors. Although detained youth are likely to receive health care-which may include HIV testing-court-involved, non-incarcerated (CINI) youth may be unlikely to receive HIV testing services either before or during their justice involvement. However, the relationship between risk factors and HIV testing among CINI youth is largely unknown. We explored the association between HIV testing and factors commonly associated with both HIV testing and HIV risk among 173 CINI youth with identified behaviors that put them at risk for HIV acquisition. Only 15.6% of participants reported a lifetime history of HIV testing, despite high rates of sexual and substance use risk behaviors. Age (older), gender (female), sexual orientation (non-heterosexual), recent marijuana use, lifetime use of other drugs, history of a sexually transmitted infection, pap smear in the past year and history of mental health/substance use treatment were all significantly associated with lifetime HIV testing. The extremely low testing rates in this sample emphasize that the juvenile justice system outside of detention is not adequately addressing youths needs related to HIV testing or ensuring access to testing services for youth at risk of contracting HIV. Results suggest that additional efforts are needed to connect justice-involved youth to healthcare more broadly and HIV testing in particular.