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Item Managing Recovery with Adults Involved in Behavioral Health and Criminal Justice Systems(2022-09-21) Hong, Saahoon; Walton, BettyYoung adults with mental health needs experience increased criminal behaviors, peaking at 16-25 years. In addition, the lack of support for young adults' behavioral health needs increases the likelihood of further involvement in the justice system. This study aimed to predict dual behavioral health and justice system involvement for adults participating in publicly funded treatment and support services needs. Policy implications were also discussed.Item Young Adults with Behavioral Health Services and Justice System Involvement(2022-09-21) Hong, SaahoonCommunimetrics highlights the team approach to sharing a vision and its goals via communication, while psychometrics focuses on efforts to identify, measure, and interpret psychological attributes and characteristics. I utilized ANSA data to identify unobserved subgroups and detect the intersectionality of dual system involvement (e.g., mental health and the criminal justice system), demographic characteristics, behavioral health needs, and race/ethnicity. Such intersectionality could be critical in the team process to assist and strengthen person-centered mental health recovery. I will also discuss the practical implications of critical factors associated with their behavioral health recovery to develop the outcome-oriented intervention.Item Collaborate, Review Data and Change; Repeat(2022-09-27) Walton, Betty; Wendy, HarroldContext. The ANSA and TCOM framework, in conjunction with related information, can support data-informed policy planning and funding initiatives. One state’s collaborative data-informed recovery strategies provide an example. The concept of recovery from mental health and substance use disorders evolved from a deficit focus to include functional and personal recovery. Through a collaborative process SAMHSA, the federal behavior health authority, developed recovery’s working definition: “a process of change through which individuals improve their health and wellness, live a self- directed life, and strive to reach their full potential” in four dimensions (Health - overcoming or managing one’s diseases or symptoms, Home – a stable and safe place to live, Purpose - meaningful daily activities, and Community - relationships and social networks that provide support, friendship, love, and hope. Recently, SAMHSA acknowledged that the 2012 framework needs to evolve and issued a Recovery Challenge to community-based organizations to highlight innovative recovery strategies and practices. The challenge requires active, meaningful involvement of individuals with lived experience. Recovery and TCOM frameworks were cross walked to support training and to inform the state’s recovery support strategies. One strategy was to create a Recovery Support Workgroup (RSW) comprised of a dozen state agencies and community stakeholders. More than 51% of RSW members have lived experience with mental health and/or substance use. This group makes data-informed recommendations to state’s Mental Health and Addiction Planning and Advisory Council. Following a statewide 2019 gap analysis, which identified recovery support needs, the RSW created subgroups to address five recovery support needs: Personal support networks, Peer support services, Hobbies and interests, Prevention and wellness, and Safe and affordable housing. Data Collection Methodology. Multiple data sources informed the subgroups’ efforts: a consumer satisfaction survey, social determinants of health survey a Lived Experience Survey distributed through recovery groups, Medicaid claims diagnoses, recovery data collected at recovery organizations, and ANSA data. All data were associated with recovery dimensions: Health, Home, Community and Purpose. For ANSA data, the process required collaboration among the state’s data management, recovery support services, and the IU CANS/ANSA technical assistance teams. Enhancing ANSA Outcome Management Reports. Outcome Management reports, available to the state team, providers, and the IU CANS/ANSA team, were modified to inform the RSW subgroups by formatting reports by recovery dimensions and additional concerns. Building on existing reports (Resolved Actionable Needs, and item level metrics (Actionable, Continuing, Clinical Progress, Newly Identified, and Worsening), three new recovery focused reports were developed. Sharing and using the data. This collaborative, data-informed recovery initiative has received national attention. A variety of strategies to disseminate and to use the results for planning and managing change will be discussed: What has worked? What has been challenging? What has not work? What are the implications for quality improvement, program evaluation, and research?Item Young Adults' Recovery: Managing Change(2022-09-27) Betty, Walton; Steven, Holland; Saahoon, HongInformed by relevant literature and combined with demographic, assessment, educational, and service information, program evaluations can identify key factor to manage change. An example follows. Background. Transition-aged youth (TAY), ages 18 to 26, have higher rates of Substance Use Disorders (SUD) than adolescents or adults over 26 years old. In 2019, 17% experienced a major depressive disorder with 12.1% having severe impairments. Overall, 30.6% experienced mental illness, and 9.7% had serious mental illness. Although TAY reported lower levels of recovery than older adults, predictors of behavioral health recovery for TAY have seldom been explored. Indiana’s Division of Mental Health and Addiction (DMHA) has funded TAY services since 2019 as an effort to positively impact this population. Methods. Qualitative information from seven currently DMHA funded programs were to support and supplement data analysis. A FFY21 Midwestern sample (n=2575) of treated young adults (ages 18-26) included 688 People of Color (POC; 12% of the sample were Black only, 0.04% Native American only, 0.06% Asian only, 5% other race only, 3% Multiracial, and 6% Hispanic); 0.73% were White only. Half were female. All youth had substance and/or mental health disorders. The Adult Needs and Strengths Assessment (ANSA) identified needs that interfered with functioning and strengths. Transportation, employment, and residential needs were identified early in care. Other need and strength items reflected status when treatment ended. In a secondary analysis of state-level data, a hierarchical linear regression predicted recovery, the rate of improved Total Actionable Items (Resolved/Ever identified needs). Predictive variables were directly entered into four blocks: 1 (race/ethnicity, gender, employment, transportation, housing stability), 2 (depression, anxiety, substance use [SUD]), 3 (involvement in recovery, SUD recovery support, social functioning, optimism), and 4 (duration of treatment, Motivational Enhancement Therapy [MET). Race was converted to POC and gender to ‘female’. Results. Each step of the regression model documented significant contributions of added variables (R2s =.013, .239, .319, .350). POC were less likely to improve than white individuals. Women were more likely than men to improve. Individuals with employment, transportation, or housing needs at the beginning of treatment were more likely to improve. Depression, anxiety, and substance use disorders decreased the likelihood of resolved needs. Poor social functioning and inadequate SUD recovery support at the end of treatment were associated with worse outcomes. Having a positive sense of oneself in the future (optimism) predicted recovery. Active involvement in recovery, longer service duration, and Medication Enhancement Therapy were related to higher rates of recovery. Discussion. In addition to addressing SUD and mental health concerns, young adults’ recovery is related to developmental tasks (employment, recreation, and social relationships), supporting involvement in managing one’s health, and developing resiliency. Attention to social determinants of health, such as transportation, is necessary for access to services and supports. Service adaptations for POC to increase involvement in recovery and equitable outcomes requires consideration and study. Managing change for TAY involves attention to developmental, cultural, behavioral health needs, the concurrent utilization/development of strengths, and monitoring progress.Item Concrete services usage on child placement stability: Propensity score matched effects(Elsevier, 2020-11) Winters, Drew E.; Pierce, Barbara J.; Imburgia, Teresa M.; School of Social WorkBackground: Experiencing poverty and financial difficulties are significant barriers to outcomes of permanency and placement stability. This is particularly true for children who are in out of home placements. The provision of concrete services is intended to meet concrete needs of families to address this barrier. However, little is known about how concrete services meet the needs of families in need of these services or if the use of concrete services is a viable treatment for children who are in out of home placements. Methods: The present study examined differences between those who received and those who did not receive concrete services on factors of stability, child and caregiver traumatic stress, number of placements, and current out of home placement. Regression analysis examined the association between amount of concrete service spending and permanency. Then to test concrete services as an intervention for children in a current out of home placement, we used propensity score matching to match participants on characteristics that predicted whether they would receive concrete services. We then ran a hierarchical regression to test the treatment condition of concrete services with children who are in a current out of home placement. Results: Participants who received concrete services were at a much higher level of need with significantly higher levels of traumatic stress and number of placements and lower levels of placement stability. The amount of money spent on concrete services was associated with increases in placement stability. And, children in a current out of home placement had an increase in placement stability when they received concrete services. Conclusions: The present study is the first to evidence concrete service as a treatment for placement stability for children in current out of home placements. Spending on concrete services in addition to child welfare services improves a child's current placement stability. This is an important finding with implications for improving child welfare services' approach to those in their care with financial burdens.Item Temporal Trends and Disparities in Suicidal Behaviors by Sex and Sexual Identity Among Asian American Adolescents(JAMA, 2021-04-01) Xiao, Yunyu; Lu, Wenhua; School of Social WorkImportance: Although suicide is the second leading cause of death among Asian American adolescents, there is a dearth of studies examining overall and possible sex and sexual orientation disparities in the trends in suicidal behaviors among Asian American adolescents. Such information is crucial to inform targeted efforts of suicide prevention among Asian American adolescents. Objective: To examine temporal trends and sex and sexual orientation disparities in trends of nonfatal suicidal behaviors in Asian American adolescents from 1991 through 2019. Design, setting, and participants: This cross-sectional study used data from the national Youth Risk Behavior Survey from 1991 through 2019, analyzing a representative sample of US adolescents in grades 9 through 12 using a 3-stage cluster-sampling design. Data were analyzed from October through November 2020. Exposures: Calendar year, sex, sexual identity, sex of sexual contact, and interaction terms of these factors. Main outcomes and measures: Crude prevalence and annual percentage changes (APCs) in self-reported suicidal ideation, suicide plan, suicide attempts, and injury by suicide attempt for the overall sample and by sex, sexual identity, and sex of sexual contacts were calculated. Sexual minorities were defined as individuals whose sexual identity was gay or lesbian, bisexual, or not sure. Results: Among 7619 Asian Americans who participated in the Youth Risk Behavior Survey from 1991 to 2019 (mean [SD] age, 16.09 [1.29] years; 3760 [47.1%] female adolescents), 1576 individuals completed the sexual identity and behaviors questions after 2015 (mean [SD] age, 15.97 [1.28] years; 810 [49.2%] female adolescents). From 2009 through 2019, there was a 1.3-fold (95% CI, -0.8 to 3.3; P = .22) increase in suicide attempts and a 1.7-fold (95% CI, -2.6 to 5.9; P = .45) increase in injury by suicide attempt among Asian American female adolescents, although these increases were not statistically significant. Among 39 Asian American adolescents who identified as gay, lesbian, or bisexual or who were attracted to and had sexual contact with partners of the same sex or both sexes, compared with 1556 Asian American adolescents who were heterosexual, prevalence was greater for suicidal ideation (24 individuals [68.2%] vs 223 individuals [15.0%]; P < .001), suicide plan (15 individuals [57.7%] vs 179 individuals [11.9%]; P < .001), suicide attempts (14 individuals [41.0%] vs 74 individuals [5.5%]; P < .001), and injury by suicide attempt (5 individuals [17.6%] vs 23 individuals [1.7%]; P < .001) between 2015 and 2019. These sexual minorities identified by sexual identity and sexual contact also had an increasing rate over this period in suicide plan (APC, 10.5%; 95% CI, 4.4% to 16.9%; P < .001). Conclusions and relevance: This study found significant increases in rates of suicide plan among Asian American adolescents who were sexual minorities identified by sexual identity and sexual contact together. These findings suggest that suicide screening needs to inquire about sexual minority status in terms of sexual identity and sex of sexual contact when identifying Asian American adolescents who are at risk for suicidal behaviors. Culturally relevant suicide-prevention programs addressing unique risk and protective factors, racial discrimination, and sexual orientation-related stigma may be needed for Asian American adolescents.Item Recovery from Problem Gambling: A Machine Learning Approach(2022-07-29) Hong, Saahoon; Walton, Betty; Kim, Hea-WonThe primary purpose of this study was to examine and identify intersections of the first wave of the COViD-19 pandemic, behavioral health needs/strengths, demographic characteristics, and recovery from problem gambling. By analyzing Adult Needs and Strengths Assessment (ANSA) datasets, we identified critical factors associated with improvement from problem gambling. In addition, we discussed risk factors that led to the continued struggling with problem gambling.Item Shared Vulnerability: Transparency as Facilitator During Pandemic Learning(Springer, 2021-11) McCarthy, Katherine; School of Social WorkThis chapter explores the intentional use of transparency while teaching an online Master of Social Work (MSW) course during the beginning of the COVID-19 pandemic. First the author recognizes how the unfolding crisis necessitated altered boundaries between herself and her students. Then the author presents four ways she used transparency to help students stay engaged and involved in the course, including changing expectations, expressing feelings, prioritizing safety and well-being, and requesting help. Finally, the author reflects upon how these Spring 2020 adjustments will inform her future pedagogy.Item Gender Bias in Employment: Implication for Social Work and Labor Studies(IUPUI, 2020) Walker, Marquita R.; School of Social WorkGender bias in employment is not a new phenomenon. The historical devalued status of women and equity-seeking groups preserved in cultural and social gendered roles permeates the workplace and contributes to institutional structures which are fashioned by and reproduced through traditional norms and mores relegating women and equity-seeking groups to secondary status roles. The question then becomes is the continuation of these reinforced structural norms in the best long-term interest of all humanity? What are we giving up when we relegate over half of the world’s population to secondary and devalued status? What gains could be made if all workers were given the same opportunities, supports, and encouragements to reach their full potential.Item Profiles of Ethiopian centenarians: A qualitative inquiry(Association for Anthropology, Gerontology, and The Life Course, 2021-11-11) Chane, Samson; Adamek, Margaret E.; School of Social WorkAs global aging advances, the number of centenarians worldwide is greatly increasing. Most of what is known about centenarians comes the Global North. It is not clear what factors contribute to longevity of centenarians in impoverished, mostly rural areas of Global South nations that still lack basic amenities. Cultural differences in the profile, lifestyles, and needs of centenarians in Africa have yet to be documented. Using a case study design, this descriptive inquiry investigated the profiles of centenarians in Ethiopia including religion, marriage, education, occupation, income, and living arrangement. Data were generated through in-depth interviews with nine centenarians (1 woman, 8 men) and were analyzed using descriptive narrative analysis. Respondents were between 100 and 108 years old. All nine were adherents of Orthodox Christianity, had been married, and were great-grandparents. Their adult lives were marked by both residential and marital stability. The Ethiopian centenarians persevered through many losses and hardships with the help of strong community-based social networks.. Unlike studies of centenarians in the Global North, most respondents were male and had strict religious upbringings. Understanding the unique profiles of centenarians in the Global South will help to inform research and practice with this growing population of the oldest-old.