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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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.
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.
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.
A Statewide Collaboration to Initiate Mental Health Screening and Assess Services for Detained Youths in Indiana.
(APHA, 2014-10) Aalsma, Matthew C.; Schwartz, Katherine; Perkins, Anthony J.; Department of Pediatrics, IU School of Medicine
Objectives. We describe a statewide effort to implement detention-based mental health screening and assess follow-up services offered to detained youths in Indiana.Methods. A total of 25 265 detention stays (15 461 unique youths) occurred between January 1, 2008, and December 31, 2011, across 16 detention centers participating in the Indiana Juvenile Mental Health Screening Project. We collected screening results and reports of detention-based follow-up mental health services and referrals from justice system records.Results. Approximately 21% of youths screened positive for mental health issues requiring follow-up. A positive screen significantly predicted that youths would receive a follow-up mental health service or referral while detained or upon detention center discharge, compared with youths who did not screen positive (61% vs 39%). Logistic regression models indicated that a positive screen was associated with (1) contact with a mental health clinician within 24 hours of detention center intake and (2) a mental health referral upon discharge. White youths were more likely than minorities to receive both follow-up services.Conclusions. Future statewide efforts to improve the mental health of detained youths should incorporate standards for providing appropriate follow-up services in detention centers.
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.
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.
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.
Behavioral Health Care Needs, Detention-Based Care, and Criminal Recidivism at Community Reentry From Juvenile Detention: A Multisite Survival Curve Analysis
(American Public Health Association, 2015-07) Aalsma, Matthew C.; White, Laura M.; Lau, Katherine S. L.; Perkins, Anthony; Monahan, Patrick; Grisso, Thomas; Pediatrics, School of Medicine
OBJECTIVES: We examined the provision of behavioral health services to youths detained in Indiana between 2008 and 2012 and the impact of services on recidivism. METHOD: We obtained information about behavioral health needs, behavioral health treatment received, and recidivism within 12 months after release for 8363 adolescents (aged 12-18 years; 79.4% male). We conducted survival analyses to determine whether behavioral health services significantly affected time to recidivating. RESULTS: Approximately 19.1% of youths had positive mental health screens, and 25.3% of all youths recidivated within 12 months after release. Of youths with positive screens, 29.2% saw a mental health clinician, 16.1% received behavioral health services during detention, and 30.0% received referrals for postdetention services. Survival analyses showed that being male, Black, and younger, and having higher scores on the substance use or irritability subscales of the screen predicted shorter time to recidivism. Receiving a behavior precaution, behavioral health services in detention, or an assessment in the community also predicted shorter time to recidivating. CONCLUSIONS: Findings support previous research showing that behavioral health problems are related to recidivism and that Black males are disproportionately rearrested after detention.
Intimate Partner Violence and Correlates With Risk Behaviors and HIV/STI Diagnoses Among Men Who Have Sex With Men and Men Who Have Sex With Men and Women in China: A Hidden Epidemic
(Ovid Technologies (Wolters Kluwer) - Lippincott Williams & Wilkins, 2015-07) Davis, Alissa; Best, John; Wei, Chongyi; Luo, Juhua; Van Der Pol, Barbara; Meyerson, Beth; Dodge, Brian; Aalsma, Matthew; Tucker, Joseph; Social Entrepreneurship for Sexual Health Research Group; Department of Pediatrics, IU School of Medicine
BACKGROUND: Intimate partner violence (IPV) research has primarily focused on heterosexual couples but has largely ignored IPV among men who have sex with men (MSM). We examined IPV prevalence among MSM and men who have sex with men and women (MSMW) in China. METHODS: Men who have sex with men older than 16 years were recruited through 3 MSM-focused Web sites in China. An online survey containing items on sociodemographics, risk behaviors, IPV, and self-reported HIV or sexually transmitted infection diagnosis was completed. Multivariate regression was used to examine associations between IPV and risk behaviors and an HIV or sexually transmitted infection diagnosis. RESULTS: Among 610 participants, 182 (29.8%) reported experiencing at least 1 type of IPV. Men who have sex with both men and women were at significantly greater risk for IPV (adjusted odds ratio [AOR], 1.65; 95% confidence interval [CI], 1.08-2.53) compared with MSM. Men who had experienced IPV were more likely to have participated in group sex (AOR, 1.86; 95% CI, 1.08-3.21), to have had sex in exchange for gifts or money (AOR, 5.06; 95% CI, 2.47-10.35), and to report a positive HIV diagnosis (AOR, 2.59; 95% CI, 1.22-5.51). CONCLUSIONS: There is a hidden epidemic of IPV among MSM in China, especially among MSMW. The hidden nature of MSM and MSMW suggests the need for a clinical environment more conducive to disclosure. Research is needed to understand the pathways linking IPV and HIV risk among MSM to optimize the design of effective interventions.
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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