Matthew Aalsma

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https://hdl.handle.net/1805/6681

Health Care Access and Utilization by Youth in Juvenile Justice

Youth involved in the juvenile justice system are known to have significant medical and mental health difficulties. Matt Aalsma is concerned about the large number of youth in the juvenile justice system who are minorities and are impoverished. Dr. Aalsma is researching ways to link these youth to the medical and mental health care they need for successful reentry into community life. To help youth get connected to needed services, a medical and mental health care screening program is being tested at the Indianapolis Juvenile Detention Center. This project is funded through a federal grant from the Maternal and Child Health Bureau.

Successful practices developed here in Indiana can have a positive impact on youth in juvenile justice systems across the country. Professor Aalsma’s research seeks to improve the lives of youth in the juvenile justice system as well as their chances for successful transition to community life.

Dr. Aalsma’s project exploring how to link youth in the juvenile justice system to needed medical and mental health care is another example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Barriers and facilitators to treatment participation by adolescents in a community mental health clinic
(2013-05-17) Oruche, Ukamaka M.; Downs, Sarah M.; Holloway, Evan D.; Burke Draucker, Claire; Aalsma, Matthew C.
An estimated 40–60% of children in mental health treatment drop out before completing their treatment plans, resulting in increased risk for ongoing clinical symptoms and functional impairment, lower satisfaction with treatment, and other poor outcomes. Research has focused predominately on child, caregiver, and family factors that affect treatment participation in this population and relatively less on organizational factors. Findings are limited by focus on children between 3 and 14 years of age and included only caregivers’ and/or therapists’ perspectives. The purpose of this descriptive qualitative study was to identify organizational factors that influenced participation in treatment, with special attention to factors that contributed to dropout in adolescents. The sample included 12 adolescent–caregiver dyads drawn from two groups in a large public mental health provider database. Analysis of focus group interview data revealed several perceived facilitators and barriers to adolescent participation in treatment and provided several practical suggestions for improving treatment participation. Implications of the findings for psychiatric mental health nurses and other clinicians who provide services to families of adolescents with mental health concerns are discussed.
Area-level incarceration and STI risk among a cohort of justice-involved adolescents and adults
(2014-11) Wiehe, Sarah E.; Rosenman, Marc; Scanlon, Michael L.; Fortenberry, J. Dennis; Aalsma, Matthew C.
Background: Living in areas of high incarceration is associated with increased risk of STI; however, STI risk with respect to both this area-level exposure and an individual’s involvement with the justice system is not known. Objective: Among individuals before and after arrest or incarceration, assess the association between area-level incarceration rates and risk of chlamydia, gonorrhea, or syphilis. Methods: Retrospective cohort study of individuals living in Marion County (Indianapolis), Indiana who were arrested or in jail, prison, juvenile detention, or juvenile prison between 2005-2008 (N=97,765). Area-level incarceration exposure was defined by the proportion of person-days incarcerated among the total population*365 within a census block group. A 1-year period was assessed before and after a randomly-selected arrest/incarceration per person. Multivariable logistic regression, controlling for age, race, STI history, and year, was performed to assess chlamydia, gonorrhea, or syphilis risk by quartile area-level incarceration exposure, adjusting for individual clustering and stratifying by gender. Results: Area-level incarceration was associated with increased odds of each STI, with a dose response relationship particularly among those with an arrest or jail stay. Women with a history of arrest or jail/prison stay and living in high incarceration areas had higher odds of STI, compared to men with comparable incarceration history and living in similar areas.
Mental Health Screenings in Juvenile Detention Centers: Predictors of Mental Health Service Utilization and Recidivism
(Office of the Vice Chancellor for Research, 2013-04-05) White, Laura M.; Aalsma, Matthew C.
Introduction: About 2 in 3 detained adolescents meet criteria for mental illness. Unfortunately, the juvenile justice system does not consistently provide mental health services for juveniles in need. As a result, juvenile adolescents have low rates of treatment utilization, high rates of recidivism, and a mortality rate 4 times greater than the general population. To understand these issues, the current study tracked a sample of detained adolescents for six months post-detention. Methods: 2089 adolescents held in a detention center completed a mental health screener. The prevalence of youths with different mental health problems was calculated. Logistic regression analyses were conducted to determine predictors of service utilization and recidivism at 3- and 6-month follow-up. Results: Altogether, 1707 (81.7%) reported trauma, 561 (26.9%) endorsed alcohol/drug use, and 393 (18.8%) endorsed significant thought disturbances. Post-detention, 336 (16.1%) utilized mental health services and 770 (36.9%) re-offended. Regression analyses indicated: (1) Hispanic youths, males, and older youths were significantly less likely to utilize services (OR=.37, p=.015 for Hispanic; OR=.53, p <.001 for males; OR=.842, p <.001 for older); (2) youths with anger problems were more likely to utilize services (OR=1.08, p=.011); (3) racial/ethnic minorities were significantly more likely to recidivate (OR=1.12, p=.009); (4) alcohol/drug use increased the likelihood of recidivism (OR=1.12, p<.001); and (5) youths who utilized services were no less likely to recidivate (OR=1.22, p=.116). Conclusions: Juveniles with mental illness problems are not getting the treatment services they need. Furthermore, Hispanic, male, and older youths were less likely to utilize services, minority youths were more likely to be re-arrested, and service use did not impact recidivism. Findings suggest gaps and disparities in mental health services for juvenile adolescents. The juvenile justice system needs to improve public policies and develop mechanisms to ensure all juveniles have an equal opportunity to receive effective mental health services.
The Experience, Impact, and Management of Professional Burnout Among Probation Officers in Juvenile Justice Settings
(Taylor and Francis, 2015) Salyers, Michelle P.; Hood, Brittany J.; Schwartz, Katherine; Alexander, Andrew O.; Aalsma, Matthew C.; Department of Psychology, IU School of Science
Little is known about the experience of professional burnout among juvenile probation officers. Following a statewide survey, 26 officers were randomly selected for qualitative interviews. Using emergent, consensus-based methods, we identified key aspects of the burnout experience. Officers described burnout in ways consistent with research definitions. Most probation officers identified negative effects of burnout, including spending less time getting to know the clients and becoming more directive. Probation officers tended to have limited strategies for managing burnout. Given the important role probation officers play in the lives of juvenile justice involved youth, more work is needed to help ameliorate burnout.
Developmental Trajectories of Religiosity, Sexual Conservatism and Sexual Behavior among Female Adolescents
(Elsevier B.V., 2013-12) Aalsma, Matthew C.; Woodrome, Stacy E.; Downs, Sarah M.; Hensel, Devon J.; Zimet, Gregory D.; Orr, Don P.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
Understanding the role of socio-sexual cognitions and religiosity on adolescent sexual behavior could guide adolescent sexual health efforts. The present study utilized longitudinal data from 328 young women to assess the role of religion and socio-sexual cognitions on sexual behavior accrual (measuring both coital and non-coital sexual behavior). In the final triple conditional trajectory structural equation model, religiosity declined over time and then increased to baseline levels. Additionally, religiosity predicted decreased sexual conservatism and decreased sexual conservatism predicted increased sexual behavior. The final models are indicative of young women's increasing accrual of sexual experience, decreasing sexual conservatism and initial decreasing religiosity. The results of this study suggest that decreased religiosity affects the accrual of sexual experience through decreased sexual conservatism. Effective strategies of sexual health promotion should include an understanding of the complex role of socio-sexual attitudes with religiosity.
Test positivity for chlamydia, gonorrhea, and syphilis infection among a cohort of individuals released from jail in Marion County, Indiana
(Wolters Kluwer, 2015-01) Wiehe, Sarah E.; Barai, Nikita; Rosenman, Marc B.; Aalsma, Matthew C.; Scanlon, Michael L.; Fortenberry, J. Dennis; Department of Pediatrics, IU School of Medicine
BACKGROUND: Individuals entering jails have high rates of sexually transmitted infections (STI), but there are few data on STI in the postincarceration period. This study aimed to describe rates of chlamydia, gonorrhea, and syphilis infection among individuals released from Marion County (Indianapolis), Indiana jails. METHODS: We conducted a retrospective cohort study of individuals incarcerated in Marion County, Indiana jails from 2003 to 2008 (n = 118,670). We linked county jail and public health data to identify individuals with positive STI test results in the 1 year after release from jail. Rates per 100,000 individuals and Cox proportional hazard analyses were performed for each STI, stratified by demographic, STI, and jail characteristics. RESULTS: We found significantly higher rates of STI in this cohort than in the general population, with rates in the 1 year after release being 2 to 7 times higher for chlamydia, 5 to 24 times higher for gonorrhea, and 19 to 32 times higher for syphilis compared with rates in the general population. Characteristics most associated with increased risk of a positive STI test result among this cohort were younger age for chlamydia and gonorrhea, older age for syphilis, black race for men, being jailed for prostitution for women, history of STI, and history of prior incarceration. CONCLUSIONS: This study found high rates of STIs among a cohort of individuals recently released from jail and identified a number of risk factors. Further study is needed to improve targeted STI testing and treatment among this high-risk population.
Perspectives of family medicine physicians on the importance of adolescent preventive care: a multivariate analysis
(BioMed Central, 2016) Taylor, Jaime L.; Aalsma, Matthew C.; Gilbert, Amy L.; Hensel, Devon J.; Rickert, Vaughn I.; Department of Pediatrics, IU School of Medicine
BACKGROUND: The study objective was to identify commonalities amongst family medicine physicians who endorse annual adolescent visits. METHODS: A nationally weighted representative on-line survey was used to explore pediatrician (N = 204) and family medicine physicians (N = 221) beliefs and behaviors surrounding adolescent wellness. Our primary outcome was endorsement that adolescents should receive annual preventive care visits. RESULTS: Pediatricians were significantly more likely (p < .01) to endorse annual well visits. Among family medicine physicians, bivariate comparisons were conducted between those who endorsed an annual visit (N = 164) compared to those who did not (N = 57) with significant predictors combined into two multivariate logistic regression models. Model 1 controlled for: patient race, proportion of 13-17 year olds in provider's practice, discussion beliefs scale and discussion behaviors with parents scale. Model 2 controlled for the same first three variables as well as discussion behaviors with adolescents scale. Model 1 showed for each discussion beliefs scale topic selected, family medicine physicians had 1.14 increased odds of endorsing annual visits (p < .001) and had 1.11 greater odds of endorsing annual visits with each one-point increase in discussion behaviors with parents scale (p = .51). Model 2 showed for each discussion beliefs scale topic selected, family medicine physicians had 1.15 increased odds of also endorsing the importance of annual visits (p < .001). CONCLUSIONS: Family medicine physicians that endorse annual visits are significantly more likely to affirm they hold strong beliefs about topics that should be discussed during the annual exam. They also act on these beliefs by talking to parents of teens about these topics. This group appears to focus on quality of care in thought and deed.
Attitudes Towards Substance Use: A Potential Mechanism in the Relationship Between Conduct Disorder and Substance Use in Detained Youth
(Office of the Vice Chancellor for Research, 2016-04-08) Kolp, Haley; Hershberger, Alexandra; Aalsma, Matthew; Cyders, Melissa A.
Background: There is a well-established relationship between conduct disorder and substance use, particularly in detained youth. Attitudes toward substance use predict alcohol and marijuana use; however, little research has investigated attitudes as a mechanism between conduct disorder and substance use specifically in detained youth. Methods: Ninety-three detained youth (Mean age=15; SD=1.346; Female=15.1%) completed a court ordered psychological assessment, which included the Substance Abuse Subtle Screening Inventory for Adolescents (SASSI-A) and the Youth Self Report (YSR) to assess alcohol and drug use, attitudes towards substance use, and conduct disorder symptomology. Results: Two mediation models were run using Andrew Hayes’ PROCESS to test the effect of conduct disorder on alcohol use and drug use (run in separate models) through attitudes towards substance use, controlling for age and gender. Conduct disorder directly related to positive attitudes toward substance use in the alcohol model (b=0.47, t(91)=4.45, p<.001) and drug use model (b=0.30, t(91)=3.33, p=.001). Conduct disorder directly related to alcohol use (b=0.32, t(89)=2.60, p=.02) and drug use (b=0.44, t(89)=3.04, p=0.003). Attitudes toward substance use were associated with higher alcohol use scores, (b=0.42, t(89)=3.99, p<.001) and drug use scores (b=0.27, t(89)=1.92, p=.06). The relationship between conduct disorder and alcohol use was significantly mediated by positive attitudes toward substance use (b=0.20, CI 0.04 to 0.42); however, the relationship between conduct disorder and drug use as mediated by positive attitudes towards substance use was non-significant (b=0.07, CI -0.003 to 0.24). Discussion: The results support that one way in which conduct disorder increases risk for substance use in detained youth is through increasing the likelihood of holding positive attitudes towards substance use. Modifying positive alcohol attitudes might be a prime point of intervention to avoid risks associated with substance use among conduct disordered detained youth.
Mortality of Youth Offenders Along a Continuum of Justice System Involvement
(Elsevier, 2016-03) Aalsma, Matthew C.; Lau, Katherine S. L.; Perkins, Anthony J.; Schwartz, Katherine; Tu, Wanzhu; Wiehe, Sarah E.; Monahan, Patrick; Rosenman, Marc B.; Department of Pediatrics, IU School of Medicine
Introduction Black male youth are at high risk of homicide and criminal justice involvement. This study aimed to determine how early mortality among youth offenders varies based on race; gender; and the continuum of justice system involvement: arrest, detention, incarceration, and transfer to adult courts. Methods Criminal and death records of 49,479 youth offenders (ages 10–18 years at first arrest) in Marion County, Indiana, from January 1, 1999, to December 31, 2011, were examined. Statistical analyses were completed in November 2014. Results From 1999 to 2011 (aggregate exposure, 386,709 person-years), 518 youth offender deaths occurred. The most common cause of death was homicide (48.2%). The mortality rate of youth offenders was nearly 1.5 times greater than that among community youth (standardized mortality ratio, 1.48). The youth offender mortality rate varied depending on the severity of justice system involvement. Arrested youth had the lowest rate of mortality (90/100,000), followed by detained youth (165/100,000); incarcerated youth (216/100,000); and youth transferred to adult court (313/100,000). A proportional hazards model demonstrated that older age, male gender, and more severe justice system involvement 5 years post-arrest predicted shorter time to mortality. Conclusions Youth offenders face greater risk for early death than community youth. Among these, black male youth face higher risk of early mortality than their white male counterparts. However, regardless of race/ethnicity, mortality rates for youth offenders increase as youth involvement in the justice system becomes more protracted and severe. Thus, justice system involvement is a significant factor to target for intervention.
Job-Related Burnout among Juvenile Probation Officers: Implications for Mental Health Stigma and Competency
(APA, 2015-08) White, Laura M.; Aalsma, Matthew C.; Holloway, Evan D.; Adams, Erin L.; Salyers, Michelle P.; Department of Psychology, School of Science
The high demands and responsibilities of probation work, particularly with juvenile clients, may lead to burnout, which can negatively impact how probation officers work with clients, particularly individuals with behavioral health concerns. Yet, research examining burnout and related outcomes among juvenile probation officers (JPOs) is limited. We surveyed 246 JPOs in a Midwestern state to identify the prevalence, predictors, and potential outcomes of burnout. JPOs reported moderate levels of burnout; about 30% of the sample scored in the high range for emotional exhaustion and cynicism. Contrary to study hypotheses, there were no group-level differences in burnout scores across gender, race/ethnicity, age, or education. In regression models, burnout was predicted by being White (vs. minority), serving in an urban (vs. rural) county, dissatisfaction with department guidelines, job dissatisfaction, viewing job role as more treatment-oriented along the enforcement−treatment continuum, and turnover intention. JPOs with burnout were more likely to endorse mental health stigma and lack of mental health competency to address juvenile clients with behavioral health concerns. Findings suggest burnout prevention and intervention programs should be considered for JPOs to increase job satisfaction, limit job turnover, reduce burnout, and possibly increase effective practices for managing juvenile clients with behavioral health needs.

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