Term Paper: Dually Diagnosed African-American and Latino Adolescents

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Dually Diagnosed African-American and Latino adolescents

DUALLY-DIAGNOSED African-American AND LATINO ADOLESCENTS: THE EFFECTIVENESS OF AN INTENSIVE DAY TREATMENT MODEL FOR AN AT-RISK COMMUNITY

Abuse of substances on the part of adolescents has grown to be a national concern in the United States and has sparked many studies in this area in the last decade. Great challenges are presented for the clinician and the substance abuse treatment system in developing and applying appropriate and effective treatment for these adolescents. Studies have shown that of the adolescents who have substance abuse disorders, many of them also have mental health illness a combination of which is termed 'dual diagnoses or co-occurring disorders. The combination of these two disorders often have devastating impacts on the adolescent, their family and this in the areas of their social, emotional, educational, and economic aspects of life.

The problem is that most of the previous research in this area focuses on the White middle class adolescent individual while the minority and traditionally underserved populations which includes ethnic and racial minorities and those of low socioeconomic status are those most at risk. This vulnerable sector of the population represents a great need in terms of treatment and that treatment must be culturally competent if it is to be effective. The characteristics of the African-American and Latino youth are different from the characteristics of the majority race youth and it is necessary to calculate these factors into any treatment programs design. Needed as well are evaluations of dual-diagnosis treatment programs for determination what treatment modalities, philosophies and approaches are effective and efficient in the provision of treatment to African-American and Latino youth.

This study utilizes a 'culturally competent, multi-systems theory-based treatment program. The purpose of this study is the determination of the effectiveness of intensive treatment for dual-diagnosis of mental illness and substance use disorder in treating African-American and Latino youth. This study uses a culturally competent, multi-systems theory-based treatment program. Furthermore, this study seeks to aid in the development of a profile that can help clinicians predict treatment outcomes for individuals seeking treatment. The profile can assist clinicians in appropriately assessing patients for the level of care and treatment needed. Research has shown that age of first substance use, family history of substance abuse, prior treatment experience, and legal status are associated with treatment outcomes. This study will determine if these factors are associated with treatment outcomes for this urban population of African-American and Latino youth. '

This study examines data from the Revelation Program, a program developed through Shields for Families, Inc. This program integrates substance abuse models and mental health treatment combined with a systemic approach that includes family, school, and community. The Revelation program was created to provide treatment that would be culturally competent and appropriate for the African-American and Latino populations who are of low socioeconomic status and who may be mono-lingual. The mission of the Revelation Program is to provide mental health services and substance abuse counseling to youth ages 13-21 that have a past or present history of drug abuse and mental illness. The aim of the program is to assist youth in sustaining a drug-free lifestyle and to equip them with skills to become independent, productive, and successful citizens. The sample will include male and female African-American and Latino youth ages 13-21. The youth will have demonstrated substance abuse and psychiatric symptoms. The youth reside in Service Planning Area 6, the South Los Angeles communities inclusive of Watts, South Central, Compton, and Crenshaw. According to population estimates, this area has the largest percentage of people of color in the county, with a breakdown in ethnicity as follows:

Latino - 59%

African-American - 35%

Caucasian - 35%

Other - 3%

This area also has the highest rates of unemployment and overcrowded housing units in Los Angeles County. The median income for this area is approximately $15,000. The youth are referred to the program through the Department of Probation, Department of Children and Family Services, Family Preservation Services, Juvenile Court, Los Angeles Unified School District, Compton Unified School District, or through other means (i.e., self, parent/family, and another Shields' program). For this study, archival data from 150 youth admitted to this intensive outpatient day treatment program from 2003-2005 will be analyzed. The study will involve a review and analysis of records collected over the past 2 years. A variety of variables that describe the patient, patient's family, and patient's environment will be examined to determine which are predictive of successful vs. non-favorable treatment outcomes. Upon intake, the individual therapist conducts a structured clinical interview with the patient and patient's parents. The therapist also completes the Adolescent Psychological Assessment. The case manager completes the Los Angeles County Participant Reporting System Registration (LACPR) and a psychosocial assessment of the patient. Upon discharge both therapist and case manager complete discharge summaries, which include program involvement, program completion, attainment of treatment goals, substance usage, psychiatric symptoms, and functioning within the family, school, and community. The case manager also completes a discharge LACPR.

Dually-Diagnosed African-American and Latino Adolescents: The Effectiveness of an Intensive Day Treatment Model for an At-Risk Community

Literature Review

I. Prevalence of Youth Diagnosed with Co-Occurring Disorders review of the literature reveals that the Youth population between the ages of 8-17 is stated to be a group with "prevalence of serious emotional disturbances referring to the range of all diagnosable emotional, behavioral, and mental disorder when the disorders disrupt daily functioning in home, school, or community." (Mental Health Offenders in the Custody of the Oregon Youth Authority April 2002) The focus was on two initial goals: 1) to determine the prevalence of diagnosed mental illness in the Youth Authority's population - both in correctional facilities and under community supervision; and 2) to identify gaps in services for youth suffering from diagnosed mental disorders and substance dependency/abuse

The study states findings of a rate of incidence of psychiatric disorders to be in actuality higher in the correctional facilities than the perilous Chicago study stated. Of the 1070 youth in the facilities there were 62% that had received a diagnosis of at least one mental health disorder and of those 57% were taking psychotropic medication prescribed to them in the individualized treatment program. Stated as the four most common psychiatric diagnoses for these youth were those of:

1) depressive disorder;

2) attention-deficit disorder;

3) post-traumatic disorder; and 4) oppositional defiant disorder. (Ibid)

Furthermore these offenders would have to learn to function in a life-long coping with their illness which may prove difficult due to the inability to easily acquire social skills and maintain healthy relationships. The prognosis for treatment and education in those with developmental disorders such as Aspergers (8% of the population at facilities) in combination creates a complex interplay between management of medication, accountability whether individual or group, personal accountability. Learning disabilities often accompany these other problems making reading and written expression difficult for these youth. The report relates that those with both substance abuse and mental health disorders comprise approximately 27% of the total of all correctional facility population. These youth acknowledge personal abuse. One-third reported sexual abuse and one -- half had reported abuse of the emotional or physical nature.. These reports were not in relation to victimization of domestic violence, seeing parents arrested, or family verbal or physical violence. Family members psychiatric history is called to be 'significant[ly] matched when they are compared to the mental health conditions of the youth in addition to the fact that 34% of the offenders were from families characterized by physical violence.

The findings state that: "While there are distinctive differences between correctional facility offenders and those under community supervision, certain similarities separate both groups from the general adolescent population. The Youth Authority's 2002 survey found that youth in its correctional facilities had a prevalence rate of a mental health condition more than three times that of the general adolescent population as reported by the Center for Mental Health Services. Furthermore, the Youth Authority's survey found that youth on parole/probation had a rate of diagnosed mental health condition more than double the general population. Similarities between both correctional facility and community supervised offenders include identical reporting of the most common mental disorders in order of prevalence: depressive disorders, attention-deficit disorder, post-traumatic stress disorder, and oppositional defiant disorder. Community supervised offenders have lower percentages in all four mental health conditions with the exception of post-traumatic stress disorder (15% for each group)." (Ibid)

The work entitled "Bridging the Gap: What We Know and Don't Know About Dual Diagnosis" states that dual diagnosis is:."..a descriptor used by clinicians and insurance companies to categorize person with severe, co-occurring mental illness and substance use disorders." (1998) Current addiction theory holds that addition is a 'chronic brain disorder with intrinsic behavioral and social-context components, similar to other forms of mental illness." (1998) Addiction, much like other diseases requires care of a long-term nature with the goal being one of reasonable treatment instead of cure. (1998; paraphrased) Young people that have been dually diagnosed… [END OF PREVIEW]

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