The red herring of adolescent mental health

An increase in adolescent distress and mental health symptoms has been clearly documented since the COVID-19 pandemic, as has increased exposure to adverse childhood experiences. Layer on top of these stressors being a youth of divorcing or separating high conflict families, and adolescent symptomatology can suddenly become a flashpoint for parental attention, division and conflict. Approaching cases using an ecological and family systems framework is necessary for accurate conceptualization and assessment of best interests in the context of child custody evaluations. Doing so ensures that adolescent mental health does not become a red herring in high conflict cases, leading to undue focus on the adolescent's mental health without considering other salient factors in the case, such as the broader parent conflict. Programs offered at the Center of Excellence for Children, Families & the Law at William James College designed to improve the lives of youth by addressing parental conflict are described.     

Intimate Partner Violence in Cohabiting Families: Reports by Multiple Informants and Associations with Adolescent Outcomes

Intimate partner violence (IPV) is common, particularly in families with children. Observing such verbal and physical aggression has consistently been linked to unfavorable outcomes for affected children. Although cohabiting families are becoming increasingly prevalent and preliminary data suggest that rates of IPV may be high in these families, little is currently known about IPV and its impact as experienced by adolescents living in cohabiting families. This study used data from low-income urban Black cohabiting families (N = 92) to (1) examine agreement of reports of verbal and physical IPV between the adolescent and the mother and between the adolescent and the male cohabiting partner (MCP) and (2) test associations between IPV and youth mental health. A higher percentage of adolescents reported the occurrence of IPV, particularly physical violence, than did mothers and MCPs. Relative to those living in minimally violent or verbally violent homes, adolescents living in verbally and physically violent homes reported higher rates of internalizing and externalizing problem behaviors. These youth also reported higher levels of self-blame for the conflict and a worse relationship with the MCP but not the mother.     

Navigating adolescent depression and anxiety in the context of parenting plan evaluations

This article touches upon theories accounting for the rise in adolescent anxiety and depression and how the prevalence of adolescent anxiety and depression affects how we navigate parenting plan evaluations. This article also discusses the importance of screening youth for depressive and anxious symptoms and assessing family, parental, and youth risk and protective factors related to adolescent depression and anxiety. This article also highlights the importance of assessing for mediating factors that increase the risk of anxiety and depression in youth in the context of parental separation, such as interparental conflict, financial difficulties, and limited contact with one parent. This article also identifies various methods of assessing depression and anxiety, including the adolescent interview, observations during the interview, and self-report measures. Additionally, this article discusses potential interventions that address mediators of the impact of divorce, such as parenting problems, family conflict, or the parent–child relationship.     

Acculturation and mental health: Response to a culturally-centered delinquency intervention

There is a dearth of research examining intervention effectiveness for ethnic minorities and few studies have investigated within-group differences in response to treatment. This study examined the prevalence of mental health problems among Anglo- and Mexican-American juveniles entering probation and their response to a comprehensive intervention designed to address drug, alcohol, and mental health in a culturally-sensitive manner. We hypothesized that all youths would demonstrate mental health improvements from pretest to posttest, and the improvements would be equal for Mexican-American youth of varying levels of acculturation and an Anglo comparison group. Participants included a total of 103 adolescents ages thirteen to eighteen years, of whom 59 percent were male and 81 percent were Mexican American. Hypotheses were supported, indicating this comprehensive, community-based intervention targeting delinquent adolescents and their families was effective in improving mental health regardless of ethnic background or level of acculturation. That is, regardless of group differences in mental health problems at intake, youth with different cultural orientations reported significantly reduced levels of internalizing and externalizing behavior problems at posttest.     

Darfur refugees in Cairo: mental health and interpersonal conflict in the aftermath of genocide

Hundreds of thousands of Darfur people affected by the Sudanese genocide have fled to Cairo, Egypt, in search of assistance. Collaborating with Africa and Middle East Refugee Assistance (AMERA), the authors conducted a mental health care needs assessment among Darfur refugees in Cairo. Information was collected using individual and focus group interviews to identify gaps in mental health care and develop understandings of emotional and relationship problems. The refugee mental health care system has a piecemeal structure with gaps in outpatient services. There is moderate to severe emotional distress among many Darfur refugees, including symptoms of depression and trauma, and interpersonal conflict, both domestic violence and broader community conflict, elevated relative to pregenocide levels. Given the established relationships between symptoms of depression/traumatic stress and interpersonal violence, improving mental health is important for both preventing mental health decompensation and stemming future cycles of intra- and intergroup conflict.     

Training parenting plan evaluators: Looking towards the future

Standards of practice for parenting plan evaluations continue to evolve, informed by advances in research and the development of innovative, evidence-based approaches to assessment and intervention. Parenting plan evaluators are asked to inform the court, parents, and other professionals on how to address the complex needs of increasingly diverse families amid reorganization, high conflict, and crisis. How can we attract and properly train new mental health professionals to do important work in an increasingly strained adversarial system? How can evaluators keep up with these advances over the course of their careers? How can they deepen and refine their skills to work with a diverse array of individuals, family constellations and an enormous range of family circumstances? And how can evaluators care for their own well-being and their colleagues? In this article, the authors describe a multi-dimensional approach to training both new and experienced custody evaluators that includes imparting baseline knowledge on how to conduct quality parenting plan evaluations as a starting point. We discuss a variety of modalities and approaches that can enable evaluators to deepen and expand their skills over the years, contribute to the diverse community of family law professionals, and manage the exceptional demands of working in this field.     

National Council of Juvenile and Family Court Judges Passes a Set of Practice Reform Resolutions

The National Council of Juvenile and Family Court Judges (NCJFCJ) recently passed resolutions and policy statements on how to improve the lives of youth and families involved with juvenile or family courts. These resolutions address the needs of homeless youth and their families, juvenile probation and adolescent development, and the need for independent oversight of youth confinement facilities.     

The Role of Emotional Security,Narrative, and Resilience for Youth and Families in Contexts of Armed Conflict

The far‐reaching devastation created by contemporary armed conflict puts children and families at risk. The goal of this article is to describe current research on the effects of armed conflict and political violence on families and youth with a focus on the roles of emotional insecurity and narratives of conflict that can persist long after the end of conflict. We describe how identity processes that are at the heart of many intergroup conflicts of the 20th and 21st centuries are linked with emotional insecurity and the historical and personal narratives of youth in these contexts. We conclude with general considerations for legal, medical, and mental health practitioners working with families who have experienced armed conflict.     

Depressive Symptomatology and Program Efficacy: Examining a Program to Improve Communication in Community Families

Destructive conflict is linked with adjustment problems over time, putting families at risk even when conflict behaviors have not reached levels of clinical concern. The Family Communication Project (FCP) is a psychoeducational program designed to improve communication in families with adolescent children. The present study examines the role of depression in program efficacy over time. Data were collected across four time points, assessing aspects of marital and family conflict, adolescent emotional security, and depressive symptoms in mothers, fathers, and adolescents. Results indicated improvements in conflict strategies for families who received the psychoeducational program (relative to controls), and point to a role of depressive symptomatology in adolescents in relation to treatment outcomes.     

Discrepancy between Mother and Child Perceptions of Their Relationship: I. Consequences for Adolescents Considered within the Context of Parental Divorce

Previous research has shown that parent-adolescent conflict is associated with adolescent adjustment. One possible source of conflict between parents and adolescents is the discrepant ways in which they perceive their relationship, which may contribute to adolescent adjustment difficulties. The present study examined the association between mother-adolescent discrepant views in their relationship and adolescent adjustment difficulties concurrently and longitudinally. In addition, the role of a family stressor, in this case parental divorce, in enhancing the discrepant views and moderating the relationship between discrepancy in perceptions and adolescent adjustment was examined. Results indicated that discrepancies in mother perception and adolescent perception of their relationship were associated with mother report of internalizing and externalizing behavior problems concurrently and longitudinally. Furthermore, discrepancies were significantly higher in divorced families than intact families, but divorce did not moderate the relationship between discrepancies and adolescent adjustment. Clinical implications and directions for future research are discussed.     

Youth Mental Health First-Aid: Juvenile Justice Staff Training to Assist Youth with Mental Health Concerns

Many youth in juvenile justice settings meet criteria for a mental health condition. Front line staff need to be able to recognize and respond to their needs, but training is often lacking. Youth Mental Health First Aid (YMHFA) is an 8-hour training for adults without mental health education to recognize and assist distressed youth. This study surveyed 1,279 [State blinded] DJS front-line staff trained in YMHFA. Of 338 returned surveys (26% response), 44% reported using YMHFA skills at work, 56% in preventing a crisis, 25% during crises. Respondents rated YMHFA as significantly improving their responsiveness to distressed young people.     

Making sense of the global health crisis: policy narratives, conflict, and global health governance

Health has become a policy issue of global concern. Worried that the unstructured, polycentric, and pluralist nature of global health governance is undermining the ability to serve emergent global public health interests, some commentators are calling for a more systematic institutional response to the "global health crisis." Yet global health is a complex and uncertain policy issue. This article uses narrative analysis to explore how actors deal with these complexities and how uncertainties affect global health governance. By comparing three narratives in terms of their basic assumptions, the way they define problems as well as the solutions they propose, the analysis shows how the unstructured pluralism of global health policy making creates a wide scope of policy conflict over the global health crisis. This wide scope of conflict enables effective policy-oriented learning about global health issues. The article also shows how exclusionary patterns of cooperation and competition are emerging in health policy making at the global level. These patterns threaten effective learning by risking both polarization of the policy debate and unanticipated consequences of health policy. Avoiding these pitfalls, the analysis suggests, means creating global health governance regimes that promote openness and responsiveness in deliberation about the global health crisis.     

Community-based forensic child and adolescent mental health services in England,Scotland and Wales: a national mapping exercise

Aim: We sought to ascertain the current nature of specialist community mental health provision for young people presenting with risk of harm to others or involvement with the youth justice system in England, Wales and Scotland. Methods: Questionnaire-based survey. Results: Fifty-five services were contacted, 48 responded and 35 of these were found to be providing some form of community mental health provision to high-risk young people. Thirteen services provided comprehensive community forensic child and adolescent mental health (FCAMH) services, whilst the remainder offered more ad hoc clinical input. Amongst the comprehensive FCAMH services, staffing, function, commissioning arrangements and population served varied widely. Conclusions: There is patchy geographical provision of comprehensive community FCAMH services across England, Scotland and Wales with heterogeneous commissioning arrangements, staffing and function. Development of a national commissioning strategy for community FCAMH services is required to ensure that the complex needs of high-risk young people are adequately addressed.     

Concussions and youth football: using a public health law framework to head off a potential public health crisis

Concussion from sport is increasingly recognized as a public health priority. In response, all states and the District of Columbia have enacted youth concussion legislation. This paper first examines key developments in concussion-related policy and legislation and then uses the findings from recent scientific studies to highlight the need to incorporate evolving scientific evidence into concussion legislation in order to better protect youth and adolescent athletes. Next, the paper discusses the framework of empirical health law research and why it should be applied in the case of concussion legislation. Finally, this paper argues that empirical health law research should be considered in any decision about whether legislation can help improve the health and safety of young players, a particularly vulnerable population whose unique needs have not yet been adequately addressed.     

Violence exposure and health related risk among African American adolescent female detainees: A strategy for reducing recidivism

Juvenile crime and violent victimization continue to be significant social problems (Fitzpatrick, Piko, Wright, & LaGory, 2005); in that, adolescents, females in particular, are likely to participate in health related risk behaviors as result of having been victimized or exposed to a violent environment. Specifically, abuse, neglect, sexual molestation, poverty, and witnessing violence are well known risk factors for the development of trauma-related psychopathology and poor outcomes relative to delinquency, drug and alcohol abuse, and HIV risk behaviors (Steiner, Garcia, & Matthews, 1997). HIV infection is a common public health concern disproportionally affecting adolescent African American female detainees. This unique population has a serious history of violence exposure, which subsequently tends to lead to engaging in risky sexual behaviors, mental health problems, and abusing substances. Also, as a result of little to no intervention, this population is recidivating at an alarming rate, a problem that may further exacerbate the expression of health-related risk behaviors among African American adolescent female detainees. The authors briefly describe a pilot program to be implemented in the juvenile justice system that is based on the Model of Accumulated Risk (Garbarino, 1996), Bronfenbrenner's Ecological Model (1994), and the Positive Youth Justice Model (Butts, Bazemore, & Meroe, 2009). The program proposes to reduce risky sexual behaviors, teach alternatives to abusing substances, treat mental health concerns, and reduce the rate of recidivism through "positive youth development", PYD (Butts, Bazemore, & Meroe, 2009). Tying elements of wraparound services and reeducation together, this program addresses salient concerns that may have an impact on an adolescent detainees' success following their release from prison in a holistic manner.     

Parent coordinators: Effective interventions in adolescent mental health

The mental health system in the US was not meeting the increasing needs of teens before the pandemic started in 2020. The pandemic served to stress adolescents and their parents while significantly limiting the availability of services. Separated parents may have disputes about whether adolescents have mental health care needs, what services the child needs, where those services will be obtained, and who will be involved. The Parenting Coordinator as a dispute resolution professional can assist families in reaching agreements and meeting their teen's needs for care.     

Mental health,substance use,and offending patterns among Native American youth in juvenile detention

Research has shown that youthful offenders in the juvenile justice system report an array of substance use and emotional and other mental health needs. The current study closely examined these issues in a large national sample (n = 539) of Native American youth drawn from the Survey of Youth in Residential Placement. Results demonstrated that frequent substance use was associated with the likelihood of being detained for a drug offense, while emotional and mental health needs were associated with detention for the most serious offenses. These results highlight the need for comprehensive substance use and other mental health assessments for Native American youth in the juvenile justice system.     

DIVORCING FAMILIES WITH YOUNG CHILDREN IN THE COURT'S FAMILY SERVICES UNIT Profiles and Impact of Services

Little is known about the families being served by court support services, or the effectiveness of the services provided. This study investigates 137 higher conflict, divorcing families with young children, who received services from the Family Services division. The study utilizes questionnaire data filled out by family services clinicians. The families presented with multiple mental health needs, including allegations of substance use and physical, emotional and sexual abuses of spouses and, to a lesser extent, children. Results detailed evaluation outcomes pertaining to joint legal and physical custody, showing an increase in joint legal custody, with little difference in physical custody arrangements. Evaluators did encourage less parental dropout. The data also profiled parents least likely to attend mandatory parenting education, accept evaluators' recommendations, and settle their case with mediation assistance. Identifying these families early can help family services clinicians track families into individualized service plans as needed.     

Access to mental health supports in England: crisis resolution teams and day services

Access to health care is a complex issue with multiple supply and demand side facets. Here just two issues are explored; the potential for access through availability and the actual access made as indicated by utilisation rates. These perspectives are explored for two mental health services, crisis resolution teams and day hospitals, both of which are recommended components for a comprehensive local mental health care service in England. The geographical spread of these services is considered alongside the level of provision and the extent of their use. Associations between availability and needs, and between use and needs are tested. Tracking resources from funding allocations to provision is also complex and issues around resource allocation are discussed.     

Systemic Self-Regulation: A Framework for Trauma-Informed Services in Residential Juvenile Justice Programs

Most youth detained in juvenile justice facilities have extensive histories of exposure to psychological trauma. Traumatic stress plays a key role in their mental health and behavioral problems and needs, and in their safety and rehabilitation and the security and effectiveness of detention facilities. We provide an overview of the barriers to successful provision of mental health services for youths in juvenile justice facilities, including those involving youth, parents, and juvenile justice residential facility staff and administrators. Next, we discuss the relevance and potential utility of approaching mental health needs using posttraumatic stress disorder (PTSD), and more broadly posttraumatic dysregulation, as an organizing framework. Examples of how a posttraumatic dysregulation perspective can enhance juvenile justice residential facility milieus and services are presented, with an overview of traumatic stress intervention models that have shown promise, or potentially could be deployed, in developing and sustaining trauma-informed juvenile justice facilities.