Kentucky Partnership for Families and Children

Barriers for Individuals
“Among adolescents with co-occurring problems, those who received only [mental health] MH treatment improved to a significant degree across MH problems but showed no improvement on SU [substance use] problems. Similarly for adolescents with co-occurring [mental health and substance use] problems who received only SU treatment, there was improvement on SU problems but not on MH problems”.1

The researchers found that adolescents with co-occurring who received dual diagnosis treatment had lower severity of antisocial behavior and increased social supports compared to those adolescents who had a co-occurring diagnosis and only received one aspect of treatment. Social supports will be what helps an adolescent through the maintenance stage of recovery.1

Barriers for Families
“Access to specialty services is also complicated by the behavior of patients and their families that shape how symptoms are defined and what are seen as appropriate pathways into care and relevant services. Adolescents with co-occurring problems who had higher levels of strengths/supports were more likely to have received dual services”.1

Barriers for Providers
“Many MH and SU services have historically been adult focused, and so the capacity to provide services for adolescents, the availability of specialized services for adolescents, and the resources committed to their treatment have been insufficient. These treatment barriers for adolescents with co-occurring disorders in rural areas are further complicated by the fact that rural programs have insufficient professional staff…”.1

“Additional training in SUD [substance use disorder] for mental health clinicians and more integrated models of specialty mental health, and SUD care may eventually improve the outcomes of these dually diagnosed individuals”.4

“…however, financial motivations and constraints may have influenced the providers’ lack of recognition of comorbidity at the comparison site given that clinicians in fee-for-service systems of care may be less likely to use diagnostic categories that might not be reimbursed”.5

Systemic Barriers
“The relationship of prior abuse to unmet MH and SU treatment needs among adolescents with co-occurring disorders in this study not only highlights the need for improved liaison between MH and SU programs but underscores the need for a collaboration between the public health and MH sectors to develop public education, community-based prevention and outreach interventions targeting adolescents and their families”.1

In the relationship between mental health services accessed by adolescents and insurance coverage, one of the key findings was that adolescents who accessed Medicaid services were more likely to seek mental health services. The implication for the field, as suggested by the authors, is that insurance benefits should be regulated by need, not by a dollar amount or other arbitrary limiter.3

Dually diagnosed adolescents are likely to have poor attendance in treatment, to be difficult to engage, and to have high rates of noncompliance and that, consequently, dually diagnosed adolescents are at increased risk for hospitalization, relapse, and poor prognosis, often because dual diagnosis is not truly addressed. If co-occurring is [reimbursed by] Medicaid, then better, more lasting treatment can be administered.2

[Research conducted on] how behavioral health screening for young people is addressed by the juvenile justice system as viewed by local, state, and federal juvenile justice officials. They found “A strong divergence of views regarding screening young people in the juvenile justice system for behavioral and substance abuse disorders…, and no consensus was achieved regarding the necessity of screening. Until consensus is achieved, it is unlikely screening will be consistently performed”.6

References

1Anderson, R. L., & Gittler, J. (2005). Unmet need for community-based mental health and substance use treatment among rural adolescents. Community Mental Health (41)1, 35-49.

2Bender, K., Springer, D. W., & Kim, J. S. (2006). Treatment effectiveness with dually diagnosed adolescents: A systematic review. Brief Treatment and Crisis Intervention (6)3, 177-205.

3Burns, B. J., Costello, E. J., Erkanli, A., Tweed, D. L., Farmer, E. M. Z., & Angold, A. (1997). Insurance coverage and mental health service use by adolescents with serious emotional disturbance. Journal of Child and Family Studies, (6)1, 89-111.

4Kramer, T. L., Robbins, J. M., Phillips, S. D., Miller, T. L., & Burns, B. J. (2003). Detection and outcomes of substance use disorders in adolescents seeking mental health treatment. Journal of the American Academy of Child & Adolescent Psychiatry, 42(11), 1318-1326.

5King, R. D., Gaines, L. S., Lambert, E. W., Summerfelt, W. T., & Bickman, L. (2000). The co-occurrence of psychiatric and substance use diagnoses in adolescents in different service systems: Frequency, recognition, cost, and outcomes. The Journal of Behavioral Health Services & Research, (27)4, 417-430.

6Thomas, J., Gourley, G. K., & Mele, N. (2004). Screening young people in the juvenile justice system for behavioral and substance abuse disorders. Journal of Psychosocial Nursing & Mental Health Services, (42)4, 28-36.

*for a one-page, formatted copy of this document, contact the KPFC office