Biomedical subjects

Arlene Rubin Stiffman

Publications and source records attributed to Arlene Rubin Stiffman.

7 recordsLinked to original sources

PubMed2006

The role of providers in mental health services offered to American-Indian youths.

OBJECTIVE: American-Indian adolescents have high rates of addiction and mental health problems but low rates of service use. The gap between service need and use appears to be even larger than the known gap for the general population, and few of the services are provided by specialists. This study examined receipt of treatment by American-Indian youths for addictions or mental health problems, the service provider who first identified a problem and sent a youth to treatment, and the extent to which the provider's knowledge and assessment predicted variance in service actions. METHODS: A sample of 401 American-Indian youths (196 from an urban area and 205 from a reservation) aged 12 to 19 years was first interviewed in person in 2001. A total of 188 of the youths' treatment providers were then interviewed. RESULTS: Structural equation modeling showed that 30 percent of the variance in addictions or mental health services provided to youths was predicted by the provider's assessment of the youth's mental health, the provider's resource knowledge, and provider type. CONCLUSIONS: The results demonstrate that professional, informal, and traditional providers play a pivotal role in providing treatment services offered to American-Indian youths and that these providers were more likely to identify a youth's problems and to offer and refer services when the provider knew more about community resources for the youth and about the youth's personal and environmental problems.

Adolescent↗

PubMed2005

Factors affecting American Indian adolescent tobacco use.

The present study merged problem behavior and social ecological theories to examine how mental health and environmental factors, including culture, were associated with American Indian youth tobacco use. A stratified random sample of 205 reservation and 196 urban American Indian adolescents living in a Southwestern area was interviewed in 2001. Two-thirds of the reservation youth and half of the urban youth in this sample reported lifetime tobacco use. Logistic regression showed that, when controlling for age and location, a mental health factor (substance abuse/dependence) and environmental factors (e.g., family members' mental health problems and peer misbehavior) were significant predictors of American Indian adolescent tobacco use. Cultural factors and location (reservation vs. urban) were not significant predictors of their tobacco use. Therefore, environmental and mental health factors should be assessed for and incorporated into tobacco use intervention and prevention plans for American Indian youth in both reservation and urban areas.

Adolescent↗

PubMed2005

Field research with underserved minorities: the ideal and the real.

The realities of doing field research with high-risk, minority, or indigenous populations may be quite different than the guidelines presented in research training. There are overlapping and competing demands created by cultural and research imperatives. A National Institute on Drug Abuse (NIDA)-funded study of American Indian youth illustrates competing pressures between research objectives and cultural sensitivity. This account of the problems that were confronted and the attempts made to resolve them will hopefully fill a needed gap in the research literature and serve as a thought-provoking example for other researchers. This study built cross-cultural bridges. Researchers worked as a team with stakeholders to modify the instruments and methods to achieve cultural appropriateness. The researchers agreed to the communities' demands for increased service access and rights of refusal for all publications and presentations. Data indicate that these compromises did not substantially harm the first year of data collection completeness or the well-being of the youth. To the contrary, it enhanced the ability to disseminate results to those community leaders with the most vested interests. The conflicts between ideal research requirements and cultural demands confronted by the researchers and interviewers in the American Indian community were not necessarily different from issues faced by researchers in other communities. Of major import is the recognition that there are no easy answers to such issues within research.

Adolescent↗

PubMed2004

Building a model to understand youth service access: the gateway provider model.

Enhancing the functioning of parents, teachers, juvenile justice authorities, and other health and mental heal professionals who direct children and adolescents to services is a major mental health services concern. The Gateway Provider Model is an elaborated testable subset of the Network-Episode Model (NEM; B. A. Pescosolido & C. A. Boyer, 1999) that synthesizes it with Decision (D. H. Gustafson, et al., 1999) and organizational theory (C. Glisson, 2002; C. Glisson & L. James, 1992, 2002). The Gateway Provider Model focuses on central influences that affect youth's access to treatment, i.e., the individual who first identifies a problem and sends a youth to treatment (the "gateway provider"); and the need those individuals have for information on youth problems and relevant potential resources. Preliminary studies by the authors and other applicable studies (D. Carise & O. Gurel, 2003) show that providers' perception of need, and their knowledge of resources, and their environment are related to the decision to offer or refer to services, supporting key aspects of the Model.

Adolescent↗

PubMed2004

Suicidal behavior in urban American Indian adolescents: a comparison with reservation youth in a southwestern state.

The majority of American Indians live off of reservations, yet research on suicidal behavior in this population overwhelmingly focuses on reservation Indians. This exploratory study interviewed a stratified random sample of 144 urban and 170 reservation American Indian adolescents to compare rates and correlates of suicidal behavior. One fifth of urban youth and one third of reservation youth reported lifetime suicidal ideation, although similar numbers (14%-18%) reported an attempt. Urban youth had fewer psychosocial problems, and in separate multivariate analyses, the groups shared no common correlate of attempted suicide. Different approaches to prevention and treatment may be warranted for urban Indian youth.

Adolescent↗

PubMed2003

Functioning mediates between symptoms and provider assessment.

The gap between service need and service use for youth with behavioral health problems is well documented. Although provider perception of need predicts service access, studies have found low associations between youth report and provider perception. This paper posits that provider perception of functioning mediates the relationship between youth need as measured by symptoms and provider assessment of that need. Interviews concerning service need and use with 792 14-18-year olds, and surveys of 222 of their providers, were analyzed through structural equation models. Functioning mediated the path from symptoms to assessment when contextual variables were not included in the model, but did not explain additional service use. However, when both contextual factors and functioning were included, the path from functioning to assessment was not significant and less service variance was explained (46% vs. 55%) than in a model not including functioning. Functioning may explain the relationship between symptoms and assessment, but organizational and individual provider variables explain service variance.

Adolescent↗

PubMed1986

A multivariate risk model for childhood behavior problems.

In a study of 306 children whose parents have a mental illness, the relationship between coping skills and environmental assets and deficits determined the degree of behavior problems among these high-risk children. Two environmental stressors (proportion of mentally ill family members and mother-child discord), two coping skills (activity competence and school competence), and an interaction (between proportion of mentally ill family members and activity competence) were found to explain 40% of the variance in child behavior problems.

Adaptation, Psychological↗