Systems Of Care For Youth Research Articles

Ethnic representation within virtual reality: a co-design study in a forensic youth care setting

BackgroundVirtual reality (VR) is one of the most cutting-edge digital technologies currently used to extend and adapt mental health interventions. When designing therapeutic VR-applications, bias related to representational and behavioral features can be introduced. Specific bias, that could result from ethnic stereotyping, should be averted. However, structured debates and clear guidelines on how to deal with such bias are lacking.ObjectiveIn the current paper we describe our iterative, co-design process to develop an augmented version of a 360-degree VR-video that is used in the Street Temptations intervention. In this intervention, aimed at adolescents with disruptive behavior problems, the VR-video provides adolescents with an emotionally engaging situation and forms the basis of Street Temptations’ perspective-taking exercises. By presenting a detailed example of our VR developmental process, specifically focusing on ethnic representation in this virtual environment and related ethical aspects, we aim to positively contribute to the creation of ethically sound therapeutic VR-applications.MethodWe adopted an experience-based co-design approach. The process started by assembling professionals’ experiences with the original VR-video. Following, we conducted four co-design groups with adolescents, young adults, and professionals within the forensic youth care system, as experiential experts, to collaboratively develop an enhanced VR-scenario for the Street Temptations intervention. In total, ten adolescents, four young adults and four professionals participated. The co-design groups were alternated with sessions with a screenwriter, to reflect on the results of the co-design groups. In this way, we enabled continuous feedback on and design of the ameliorated scenario and let development and data collection reinforce each other.ResultsThe most important adjustments that were brought forward included explicit incorporation of diversity, establishing a clear storyline for the scenario, keeping the content close to reality, casting actors in a way to avoid obvious stigmatization, and using only names for the characters that are commonly used across different cultural and ethnic backgrounds.DiscussionBy presenting our developmental process, we give a detailed example of how to reflectively develop ethically sound therapeutic VR-content within a forensic youth care setting. We demonstrated that including stakeholders can help in preventing socially irresponsible and conceivably hurtful stereotypes. By describing the process in detail, we hope to contribute to the responsible use of technology within mental health care.

“Being in the system is really difficult and…I wouldn’t wish it on anybody.” Trauma and the public sector system of care for youth

Youth involved in public sector services for substance use and other forms of mental health, juvenile justice, foster care, or homelessness report higher rates of trauma compared to the general youth population. We interviewed 26 youth, ages 14–21, with lived experience in public systems of care for the purpose of a state-contracted needs assessment evaluation. Qualitative analysis of these data indicated trauma occurs sequentially vis-à-vis the system of care. Participants experienced family adversity and a lack of social support, which has been defined as pre-system trauma. Because of this pre-system trauma, youth were referred to the public sector system of care. Rather than resolving trauma, system involvement exacerbated existing trauma and introduced new forms of trauma, defined as system-based trauma. Existing policies and practice address pre-system trauma, though there is room for improvement for both pre-system and system-based trauma. The field has yet to reckon fully with system-based trauma and this may be the next transformation for public sector youth services.

From paper to practice: implementing integrated care for youth-at risk

Background: At present, professionals experience difficulties applying known facilitators and barriers of integrated care in practice [1]. This is particularly intricate when working with youth at-risk and their families. These families have a diversity of problems in different life-areas, that often do not seek or accept care, and with a continuing risk of crisis situations occurring. To improve integrated care for youth at-risk, we aimed at deepening insights into how to enable facilitators or overcome barriers when implementing integrated care for youth at risk.
 Targeted population and stakeholders: The overall study design comprises practice-based action research. The primary focus of this study is on the perspective of Youth Care professionals, policymakers and youth at-risk in the Dutch Youth Care system. This study is designed and monitored in co-creation with professionals, policymakers and youth representatives. By organizing learning sessions based on the results of the study, professionals and other stakeholders are stimulated to learn and improve the quality of care for youth at-risk. 
 Method: For the aim of this study, we conducted 31 semi-structured interviews, observations with different stakeholders and one learning session with a youth and parent representative, professionals, and policymakers within a network of an integrated care initiative for youth at-risk. To analyse the transcripts, learning session and observation reports, we conducted a thematic analysis both deductively and inductively.
 Results: The implementation of integrated care for youth at risk seemed to be influenced by three underlying mechanisms: mandate, care coordination, and professional autonomy. Neither mandate, nor care coordination, nor professional autonomy was reported as lying with one person or organization and shifted between them depending on the specific case. When there was a lack of, or insufficient agreement on professional autonomy, mandate, or care coordination, it became extremely difficult for the professionals involved to provide integrated care in practice. Specifically in crisis situations, when clarity on mandate, care coordination, and professional autonomy was urgent but often lacking in practice. This led to indecisiveness and inappropriate support or no care provision at all. At the same time when these mechanisms were present: integrated care for youth at-risk was more easily realized. 
 Conclusions: Providing integrated care for youth at-risk is a joint effort. The different organizations need to specify with every new case who is involved and what their role and responsibility is, in order to offer youth at-risk the care they need. Therefore, professionals and organizations need to realize, understand and act on the underlying mechanisms mandate, care coordination and professional autonomy when providing integrated care for youth at-risk. Future studies are needed to establish whether and if so, what, other underlying mechanisms are crucial when providing integrated care for youth at risk in practice and how these mechanisms are successfully implemented. 
 Reference: 1.Nooteboom LA, Mulder EA, Kuiper CH, Colins OF, Vermeiren RRJM. Towards integrated youth care: A systematic review of facilitators and barriers for professionals. Administration and Policy in Mental Health and Mental Health Services Research. 2020;48(1):88–105.

Eliminating disparities in youth substance use among Native Hawaiian, Micronesian, and sex and gender minorities: A qualitative needs assessment from interviews with public service leaders.

Youth substance use (SU) has been linked to adverse mental health outcomes. For those youth involved in public sector systems of care, reports of SU are consistently high compared to general populations. These public sector services systems of care include mental health, juvenile justice, child welfare, homeless intervention services, as well as SU service systems. In addition, minority and marginalized youth tend to report disproportionately high SU. As an example, in Hawai'i, youth who are Native Hawaiian (NH), Micronesian, or who identify as sexual or gender minorities not only report elevated rates of SU, but are overrepresented in public sectors. In order to reduce youth SU health disparities, access to and quality of the system of care for youth must improve. To inform systems change, this needs assessment study used qualitative methods to engage professionals in Hawai'i working within public sectors that may intersect with youth SU service system of care. Professionals identified several themes which have implications for practice, policy, and research: colonialism and inclusivity at the macro level, the need for policies at the exo level, meso level changes regarding family and community, and stigma and discrimination at the micro level. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

State Strategies for Enhancing Access and Quality in Systems of Care for Youth with Complex Behavioral Health Needs.

The investigators conducted a qualitative study with state administrators and policymakers about the financing and policies that structure public systems of care for children with complex behavioral healthcare needs. The objective was to characterize diverse strategies states employed to enhance funding for, access to, and quality and effectiveness of home and community-based services (HCBS) for these youth. States report using a wide variety of creative solutions while navigating the unique needs and constraints of their political and economic environments. Findings can benefit public officials, researchers, and advocates by advancing knowledge-sharing of public policy-making and resourceful problem-solving.

Towards integrated care in the Dutch Youth Care system: an action based research

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)

Mental Health Crisis in Youth With ASD

This Symposium’s goal is to provide guidance to the child and adolescent psychiatrist in private practice in assisting families who are struggling to manage their child with ASD and in crisis. Evidence shows that almost 70% of youth with ASD have one form of mental illness, 56% of individuals with ASD have a history of aggression toward their caregivers, 30% are found to engage in self-injurious behaviors, and 49% have a history of elopement. Individuals with ASD are also 28 times more likely to report suicidal ideation. Sometimes these problems can spiral out of control and result in a full-blown mental health crisis. The impacts of crisis are serious and include loss of school placement, police involvement, and frequent and prolonged emergency department visits and inpatient mental health hospitalizations. The goal of this Symposium is to inform child and adolescent psychiatrists about the available systems of care for youth with ASD who are experiencing a mental health or behavioral crisis.

Transition and transformation in youth care in the Netherlands

PurposeSince January 2015, the Dutch youth care system has been under construction. Its focus has shifted from the problematic to the normal development of children. Emphasis on the capacities of both youths and parents, on customized care and on better cooperation between professionals should decrease the use of specialized services. This reconstruction of the youth care system not only appeals to the competencies and skills of professionals, but also requires innovations in terms of leadership. The purpose of this paper is to describe the struggle managers face when working to transform the youth care system, and to provide some suggestions for how managers can be supported.Design/methodology/approachThis paper is based on the results of two empirical, qualitative studies that were recently conducted by the Research Institute Youth, which is part of the Health Care and Social Work Research Centre of Windesheim University of Applied Sciences in Zwolle, the Netherlands. Over the course of a preliminary study, executive managers of five youth care organizations were interviewed on the ongoing transformations of their organizations and the changing roles and needs of managers within these transformations. Subsequently, 13 middle- and first-line managers of 3 youth care organizations were interviewed about their experiences and the ways in which they have handled the new roles they have taken on in transforming their organizations.FindingsThe management of youth care organizations is responsible for facilitating professionals in taking on and shaping their new roles, thus affecting not only the structure but also the culture and practices of youth care organizations and of management itself. This research shows that managers are struggling with these changes in their own ways. While youth care managers are struggling with their new roles and responsibilities, the intended transformation of the youth care system lags behind. Appropriate support of managers is essential, but is currently lacking. This paper provides some suggestions for how managers can be supported.Originality/valueThis paper identifies and explains the challenges that top-, middle- and lower-level managers face in current transformation processes in social service organizations, and provides some suggestions for how managers can be supported in these processes.

Het evidence-beest en de normativiteit van opvoeding

Abstract The Evidence ‘Beast’ and the Normativity of Child-Rearing In 2008 Micha de Winter warned people to watch out for, what he coined, ‘the Evidence Beast’, referring to a too narrow focus within the Dutch youth care system on evidence and effectivity. This concern was also the main instigator for my PhD research conducted under his (and Prof. Koops’) supervision. In this article I address some of the ‘beasts’ of a strict evidence-based focus within the professional field of youth care. Some of these problems are related to the ways in which EBP is used in the Dutch youth care system (a strict focus on effectivity, a lack of professional reflection and a lack of professionals’ discretionary power). The most important and most Dewinterian issue however is the implicit normativity in child rearing in contrast to the rather technical, and presumed neutral, child rearing approach in youth care interventions. I conclude the article with several suggestions for the future, in order to give more room to important value-laden elements in the support that is offered to parents through youth care interventions.

Engaging Youth in a Mental Health System Improvement Initiative in Ontario: Developing the Be Safe Resource

Youth engagement can improve the accessibility, effectiveness, and sustainability of programs and resources for youth. Little is known about youth engagement in system-level initiatives. As part of Systems Improvement through Service Collaboratives, an Ontario initiative that aimed to improve the system of care for youth with mental health or addictions needs, youth and adults in London, Ontario partnered to co-create Be Safe. The Be Safe resource helps youth manage mental health crises and identify local services. This article showcases a youth-adult partnership in a system-level initiative, and highlights a replicable strategy for developing resources relevant to youth needs and preferences.

Extending systems thinking in planning and evaluation using group concept mapping and system dynamics to tackle complex problems

Group concept mapping (GCM) has been successfully employed in program planning and evaluation for over 25 years. The broader set of systems thinking methodologies (of which GCM is one), have only recently found their way into the field. We present an overview of systems thinking emerging from a system dynamics (SD) perspective, and illustrate the potential synergy between GCM and SD. As with GCM, participatory processes are frequently employed when building SD models; however, it can be challenging to engage a large and diverse group of stakeholders in the iterative cycles of divergent thinking and consensus building required, while maintaining a broad perspective on the issue being studied. GCM provides a compelling resource for overcoming this challenge, by richly engaging a diverse set of stakeholders in broad exploration, structuring, and prioritization. SD provides an opportunity to extend GCM findings by embedding constructs in a testable hypothesis (SD model) describing how system structure and changes in constructs affect outcomes over time. SD can be used to simulate the hypothesized dynamics inherent in GCM concept maps. We illustrate the potential of the marriage of these methodologies in a case study of BECOMING, a federally-funded program aimed at strengthening the cross-sector system of care for youth with severe emotional disturbances.

51.0 Systems of Care for Youth With Physical Illness

Chronic physical illness is associated with increased risk for mental health problems, including depression and anxiety. Outside of pediatric consultation-liaison settings in medical hospitals that care for adolescents with chronic physical illness, there are few specific programs aimed at preventing and treating the unique mental health problems faced by adolescents with physical illness. The goal of this presentation is to share examples of specific programs developed to provide psychiatric care across the continuum, including outpatient, partial hospital, and inpatient levels of care, and to describe activities of prevention, including group mentoring and health coaching.

Analyzing the Hidden Curriculum

Values play an important part in the childrearing practices of parents, but are hardly a subject of debate in discussions about the youth care system. Also, a reliable research instrument for an investigation of values in this specific field is not readily available. In this article we will present our research design, which will make such an investigation possible. The framework we use is based on an existing theory and model of universal values ( Schwartz, 1992 ). Our adapted framework consists of 39 universal values and can be used for the content analysis of documents. It offers the opportunity for an objective, empirical analysis of values. Next to an elaborate description of this framework, a case study will be presented as an example of how this method can be used.

Implementation and sustainability of statewide transition support services for youth with intellectual and physical disabilities.

Significant gaps in care and limited existing models establish the need to innovate systems of care for youth with special health care needs in the transition between pediatric to adult health care settings. Using implementation science, a statewide transition support program was created. University and community partners explored needs and adopted a strategic plan and funding sources. The existing consensus statement provided a framework. A team was hired, policies were piloted and the initial ambulatory consultative transition service for youth with special needs ages 11 to 22 was launched. Full program activities during year four were analyzed. During 2011, there were 139 consultations for youth with intellectual disability and/or physical disability (average 16.74 years, 46% female). Services include routine and focused co-morbidity screening and recommendations, care coordination of complex health and community service needs, and support for families. The evolving transdisciplinary team adapted their methods to collaborate with a growing population of youth and primary care providers. A statewide transition support program is a viable delivery model to provide needed resources for youth, families and primary care practices. Weekly improvement meetings continue to adapt services to sustain family satisfaction and community provider satisfaction.

Stakeholder Management in the Youth Care System

Our research focuses on stakeholder theory in the public sector, in the non-profit sector and in the service sector. More specifically, we apply stakeholder theory to the case of the residential homes for youth care. Our research showsthat youth care system does not use stakeholder management in a formal way. The notion of ‘stakeholder’ has not been established yet. But when considering the practice, one can observe an effective use of stakeholder management as the interest of the various stakeholder groups is taken into account by the youth care management. Our research illustrates the different roles and the complementarities between stakeholder management and participative management. While stakeholder management is important for strategic decision making, participative management is more important for the operational side of management. From a theoretical perspective, our research highlights the discussion on the influence or the claimant definitions of the concept of stakeholder. It also invites to reflect on the relevance of the concept of stakeholder democracy. This case illustrates that important stakeholders such as the customers, the youth and their parents, and also the employees valuate participation on the operational level as more important than participation in the board and in the strategic management decision making in the organization. By disentangling the distinction between the operational and policy level of stakeholder management, our research links participative management and stakeholder management while at the same time clarifies the application of stakeholder management in the non-profit system.

Values and Youth Care Interventions: The Case of Triple P

Currently, the child-care system is dominated by an emphasis on preventive and early interventions. In the Netherlands specifically, the former Ministry of Youth and Family (2007–10) has incited a transition of the youth care system towards more preventive and effective care for children and youth. With this tendency comes a strong focus on evidence-based practices. This focus on effectiveness, however, leaves another important element of interventions largely unspoken. Youth care interventions are also influenced by values and beliefs of its developers and of the professionals working with these interventions. Our investigation turns the attention to these unspoken values and beliefs through the content analysis of relevant documents, interviews and observations of such a preventive intervention, namely Triple P. The results show that, in the case of Triple P, the intervention is not only highly individualised, but it also sends across contrasting messages of ‘free choice’ versus adjustment to and conformation with the norms of society.

Disparities in Psychiatric Emergency Department Visits among Youth in Hawai'i, 2000-2010

To describe the frequency and patient characteristics of emergency department encounters for mental health among youth, and to examine differences in utilization and treatment patterns. Data were obtained from the Hawai'i Health Information Corporation database of emergency department records between January 1, 2000, and December 31, 2010. Analyses were limited to records of visits by patients aged <18 years with a diagnosis of mental disorder or a suicide attempt. The annual average rate was 49.7 emergency department visits related to mental health issues per 10 000 youth, accounting for 2.1% of all emergency department visits among youth. Rates of mental health-related visits significantly and steadily increased, from a low of 25.8 in 2000 to a high of 67.4 in 2010. Rural areas consistently exhibited higher rates and acceleration at a steeper incline across time. Rural youth were more likely to be discharged or transferred for inpatient care or outpatient services compared with urban youth (6.3% vs 12.4%; χ(2)=61.42; df=3; P<.001). The trend in emergency department utilization for mental health-related issues in adolescents is apparently increasing, with significantly higher rate and morbidity for youth in rural areas. Several recommendations are described for creating a responsive and integrated system of mental health care for youth, covering training, consultation, screening, and brief interventions.

Innocence Lost: Care and Control in Dutch Digital Youth Care

The Dutch National Reference Index is the political answer to public outcry about a number of well-publicised cases in which the tragic deaths of very small children were connected with a failing youth care system. The parallel with the tragic UK case of Victoria Climbié in 2003, which catalysed the reform and digitisation of the UK policy system of child and youth care, is striking. Analysing the development of the index in the Netherlands, we perceive a ‘double translation’: first, how public sentiment is translated into a database tool and, second, how nationally formulated aims and guidelines for the tool are translated into local practices. Where the national system is firmly rooted in the idea and ideal of the care for children at risk and uses tools of communication to achieve this, other functions are tagged on in the development of the local systems. The system at the local level enables professionals to monitor each other's decisions; there is a direct surveillance at the managerial level (on professionals) and an increased control of the municipality on the various agencies that constitute the local youth-care system. We conclude that using ICT in social policy is not just a power-neutral digitalisation of existing processes, but that it alters the character of these processes and brings along unforeseen functions and risks. The dominant goal of ‘care’ for children is supplemented with elements of ‘control’ within the organisation of local youth care. In this sense, the basic idea of the National Reference Index itself loses some of its innocence, too.

Ten-Year Time Trends in Emotional and Behavioral Problems of Dutch Children Referred for Youth Care

Emotional and behavioral problems assessed with the Child Behavior Checklist (CBCL) were analyzed from 2,739 Dutch children referred to Families First (FF) or Intensive Family Treatment (IFT) from 1999 to 2008, to examine time trends. From the year 2004 onward, six of the eight CBCL-syndrome scales yielded significant decreases from the reference year, 1999. Analyses of statistical interactions indicated that on some scales in later years, younger children and boys scored lower than in 1999, and children referred to FF showed more delinquent behaviors in later years compared with in 1999; whereas, children referred to IFT showed less delinquent behavior than in 1999. These results might be explained by structural changes in the Dutch youth care system, by a huge growth of the number of treated children, by an incident in Dutch youth care, and also by the introduction of new methods of home-based treatment for delinquent youth. An implication of the current results is to consider home-based services more seriously as an alternative for out-of-home placement.

Supporting the Need for an Integrated System of Care for Youth with Co‐occurring Traumatic Stress and Substance Abuse Problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.