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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4. Getting A Grip On My Depression: A Grounded Theory Explaining How Latina Adolescents Experience, Self-Manage, And Seek Treatment For Depressive Symptoms
(Journal of Adolescent Health, 2019) McCord Stafford, Allison; Aalsma, Matthew C.; Bigatti, Silvia M.; Oruche, Ukamaka M.; Burke Draucker, Claire
Latina adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than White peers. Although evidence-based treatments exist to treat adolescent depression, few treatments have been modified to meet the cultural needs of this population. In order to develop culturally sensitive strategies for preventing, identifying, and treating depressive symptoms in Latina adolescents, it is necessary to understand how they experience, self-manage, and seek treatment for their depressive symptoms over time from their own perspective. The purpose of this study was to develop a theoretical framework that explains how Latina adolescents experience, self-manage, and seek treatment for their depressive symptoms.
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.
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.
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.
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.
Burnout and Mental Health Stigma among Juvenile Probation Officers: The Moderating Effect of Participatory Atmosphere
(Springer, 2019-03) Dir, Allyson L.; Saldana, Lisa; Chapman, Jason E.; Aalsma, Matthew C.; Pediatrics, School of Medicine
Despite high rates of mental health problems among juvenile justice-involved youth, mental health stigma among juvenile probation officers (JPOs) is under-studied. This cross-sectional study examined effects of job burnout and workplace participatory atmosphere on mental health stigma among JPOs across Indiana (n = 226). Participatory atmosphere moderated the relationship between JPO burnout-related cynicism and mental health stigma (interaction β = - 0.14, p = .04); burnout was related to greater mental health stigma at low levels of participatory atmosphere. Findings suggest participatory atmosphere mitigates effects of burnout on mental health stigma among JPOs. Organizational-level interventions might help to reduce mental health stigma and combat negative effects from burnout among JPOs.
Caregiver Comfort in Adolescents Independently Completing Screening Tablet-Based Questionnaires at Primary Care Visits
(Elsevier, 2019-09-12) Ferrin, Stephanie N.; Grout, Randall W.; Gilbert, Amy Lewis; Wilkinson, Tracey A.; Cheng, Erika R.; Downs, Stephen M.; Aalsma, Matthew C.; Pediatrics, School of Medicine
Objectives The objective of this study was to assess caregiver comfort regarding adolescent completion of computerized health screening questionnaires created for adolescents. Design We conducted a mixed method, cross-sectional survey of caregivers of adolescent patients (n=104) ages 12–18 years that had a medical visit between June and August of 2017. Topics assessed included who completed the questionnaire, caregiver comfort and concern regarding questionnaire data, and caregiver reasons for involvement in completing the questionnaire. A one-way ANOVA was used to compare age of the adolescent and caregiver involvement in the questionnaire. Results The majority of adolescents (64%) reported independent completion of the questionnaire. Thirteen percent of caregivers completed the questionnaire with no involvement of the adolescent and 23% reported that caregivers and adolescents completed the questionnaire in tandem. The majority of caregivers (84%) were comfortable with adolescents completing the questionnaire. A variety of reasons were identified for caregivers completing the questionnaire (time constraints, 22%; adolescent requested caregiver help, 19%; caregiver desired to answer questions, 14%; caregiver did not realize that the questionnaire was intended for the adolescent, 11%; caregiver believed that the adolescent was too young to respond alone, 11%. Caregiver comfort with adolescent completing the questionnaire increase with age. Conclusion We found the reason most caregivers gave for completing the questionnaires were related to clinic processes (e.g. time constraints) Caregivers were more likely to complete the questionnaire with younger adolescents. Thus, pediatricians should consider how to best prepare families for initial questionnaires in primary care.
Characteristics Associated with Confidential Consultation for Adolescents in Primary Care
(Elsevier, 2018-08) Gilbert, Amy Lewis; McCord, Allison L.; Ouyang, Fangqian; Etter, Dillon J.; Williams, Rebekah L.; Hall, James A.; Tu, Wanzhu; Downs, Stephen M.; Aalsma, Matthew C.; Pediatrics, School of Medicine
OBJECTIVE: To examine how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. STUDY DESIGN: This prospective cohort study was conducted as part of a larger study implementing computerized clinical decision support in 2 urban primary care clinics. Adolescents used tablets to complete screening questions for specified risk factors in the waiting room. Adolescent-reported risk factors included sexual activity, substance use, and depressive symptoms. Providers were prompted on encounter forms to address identified risk factors and indicate whether confidential consultation was provided. Provider types included adolescent medicine board certified pediatrics and general pediatrics. Differences in proportions of adolescents reporting risk factors by provider type were assessed using χ2 tests. Associations between adolescent characteristics, risk factors, and provider-reported confidential consultation were examined using logistic regression analyses. RESULTS: The sample included 1233 English and Spanish-speaking adolescents 12-20 years of age (52% female; 60% black; 50% early adolescent). Patients seen by adolescent medicine board certified providers reported sexual activity, depressive symptoms, and substance use significantly more often than those seen by general pediatric providers. Among patients seen by board certified adolescent medicine providers, confidential consultation was provided to 90%. For those seen by general pediatric providers, confidential consultation was provided to 53%. Results of multiple logistic regression demonstrated that female sex, later adolescence, and clinic location were significantly associated with confidential consultation. CONCLUSIONS: Provider training is needed to reinforce the importance of confidential consultation for all adolescents.
Conduct disorder symptoms and illicit drug use in juvenile justice involved youth: The reciprocal relationship between positive illicit drug use attitudes and illicit drug use
(Taylor & Francis, 2018-07-03) Kolp, Haley M.; Hershberger, Alexandra R.; Sanders, Jasmyn; Um, Miji; Aalsma, Matthew; Cyders, Melissa A.; Psychology, School of Science
Conduct disorder (CD) symptoms cooccur at high rates with illicit drug use in juvenile justice involved youth, which results in poorer outcomes; however, research has not identified where best to intervene in this relationship, limiting the identification of modifiable risk factors to reduce negative effects of CD symptoms. Two mediation models were examined to investigate the potential for CD symptoms to influence a reciprocal relationship between illicit drug use and positive drug attitudes, controlling for age, gender, and race. Data were examined for 245 juvenile justice involved youth (mean age = 15.46, SD = 1.30, range 12-18, 64.9% Black, 80.4% male) who completed court-ordered psychological assessments. Findings indicate: (1) Positive attitudes toward illicit drug use significantly mediated the relationship between CD symptoms and illicit drug use (β = 0.16, CI 0.09-0.27; test for indirect effect z = 4.17, p < .001) and (2) illicit drug use significantly mediated the relationship between CD symptoms and positive attitudes toward illicit drug use (β = 0.20, CI 0.12-0.32; test for indirect effect z = 4.87, p < .001). Overall, the present study suggests that CD symptoms impart risk for illicit drug use both indirectly, through more positive attitudes toward illicit drug use, and directly, which further strengthens positive attitudes toward illicit drug use.
Detained Adolescents: Mental Health Needs, Treatment Use, and Recidivism
(AAPL, 2016-06) White, Laura M.; Lau, Katherine S. L.; Aalsma, Matthew C.; Department of Pediatrics, IU School of Medicine
Objective: Although approximately 60%-70% of detained adolescents meet criteria for a mental disorder, few receive treatment upon community reentry. Given that mental health treatment can potentially reduce recidivism, the study examined detained adolescents’ mental health needs and their post-detention mental health treatment and recidivism. Method: Altogether, 1574 adolescents (<18 years) completed a mental health screener at a detention center. Scores on the screener, mental health treatment utilization (60-days post-detention), and recidivism (6-months post-detention) were measured. Results: About 82.2% of adolescents earned elevated scores on the mental health screener, but only 16.4% utilized treatment and 37.2% recidivated. Logistic regression models revealed adolescents with insurance and higher Angry-Irritable scores were significantly more likely to obtain treatment, whereas males, Black adolescents, older adolescents, and adolescents endorsing a trauma history were less likely. Black adolescents, insured adolescents, and adolescents with higher Alcohol/Drug Use scores were significantly more likely to recidivate. Mental health treatment increased the likelihood of recidivism. Discussion: The prevalence of mental health needs among DAs was high, but treatment utilization was low, with notable treatment disparities across race, gender, and age. The use of mental health treatment predicted recidivism, suggesting treatment may act as a proxy measure of mental health problems. Future research should assess the impact of timely and continuous mental health services on recidivism.

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