Finding the Balance in Evolving Service Sectors for Youth with Co-Occurring Disorders: Measurement and Policy Implications

Abstract

SUMMARY This research assessed the extent of unmet service needs for rural youth with co-occurring mental illness and substance use problems, and the factors that predicted service utilization. All youth (age 12–18 years) living in a six-county region of Iowa and discharged from outpatient mental health or substance use treatment were included (n = 150). Chart review using the Child and Adolescent Needs and Strengths-Mental Health tool (CANS-MH) was used to retrospectively assess clinical and socio-environmental characteristics at time of admission and discharge and service utilization. Findings suggest that in spite of national practice standards that recommend both mental health and substance use services for people with co-occurring disorders, fewer than 20% of all youth received both mental health and substance use treatment. Data also show that a greater degree of depression and prior mental health and substance use residential care service utilization predicted the receipt of dual treatment. Conclusions from this research discuss the roles that measurement and policy can play in evolving service sectors and systems to better address the needs of rural youth with serious emotional disturbance and their families. Further, findings suggest attention to early assessment and appropriate intervention for the treatment of co-occurring disorders may play a critical role in treating rural youth and their families in their communities, limiting the over-reliance of residential care and other out-of-home placements.