Adolescent American Indian Multi

Adolescent American Indian Multisector
Help Investigation (AIM-HI)

Principal Investigator: Arlene Rubin Stiffman, Ph.D.
Funder: National Institute on Drug Abuse (NIDA – R01 DA13227)
Timeframe: Funded: 9/00-8/07
Affiliation:         Comorbidity and Addictions Center (CAC)
                            Kathryn M. Buder Center for American Indian Studies
                            Center for Mental Health Services Research (CMHSR)

Affiliated Researchers:

Ed Brown, DSW, Co-Principal Investigator
Linda Cottler, Ph.D., Investigator

Matthew Howard, PhD, Investigator

David Pollio, Ph.D., Investigator

James R. Moran, PhD, Investigator

Carol North, MD, MPE, Investigator

Lee Robins, PhD, Investigator

Edward Spitznagel, Ph.D., Statistician

Project Contact: Arlene Stiffman, PhD, Director of the Comorbidity and Addictions Center

Phone: (314) 935-6685, arstiff@wustl.edu

Project Update as of 01/25/08:
Stage: Completed collecting data on youth and providers. Focusing on data analyses.
Practice or Policy Implications: American Indian youth have high rates of personal and environmental problems. American Indian youth receive services from multiple informal providers, although their access to services is low. Urban youth have less professional and specialty services than reservation youth and less comprehensive helper networks.

Description:

Despite the high rates of drug and alcohol and other co-occurring mental health problems among American Indian youths, we know little about their service access or utilization. Due to American Indians’ Trust relationship with the U.S., their health care system (The Indian Health Service) developed separately from other federal and state programs. Although today they are eligible to receive state funded health and mental health services, political resistance, administrative difficulty in accessing Medicaid reimbursement, and lack of on-reservation services impede access differentially for urban and reservation-based youths. The prospective longitudinal AIM-HI study (Adolescent American Indian Multisector Help Inquiry) will provide a comprehensive picture of youths’ needs for help, their help-seeking pathways in multiple service sectors, and the consequences of help on their later development of drug and other mental health problems.

The study has three aims:

To test two hypotheses based on a heuristic model of service use that includes multisector service use and gateway provider role in need identification and access (see Figure 1).
1. Youths’ use of services for their drug or comorbid problems is determined by:

i. Their need, their predisposing characteristics, and service enabling characteristics;

ii. Their need as perceived by gateway providers; and

iii. Those gateway providers’ resources, service connections and service knowledge.

After controlling for baseline environmental factors and needs, American India youths who have accessed and utilized more extensive and intensive services for their drug use and related behavioral problems will be less likely to have impaired functioning and substance misuse, abuse or dependence.

To test a hypothesis concerning the consequences of service reimbursement:

The use of specialty substance-use services is positively associated with the availability and accessibility of Medicaid and managed care reimbursement to those services.

To document issues of concern to American Indian policy planners:
1. The prevalence, severity and duration of substance abuse and co-occurring mental health problems, as well as the protective and risk factors for those problems;
2. The multisector configurations of preventive and interventive services and their complementary or supplementary relationships, such as between traditional and specialty sector services, and
3. The relationship between barriers (which change over time) and changes in configurations of services accessed.

AIM-HI's impact on research, service delivery, and policy development is accelerated by the participation of American Indian community representatives; the association of its PIs (Dr. Arlene Stiffman and Dr. Eddie Brown) with the George Warren Brown School of Social Work’s Center for Mental Health Services Research, and the Kathryn M. Buder Center for American Indian Studies; as well as the collaboration of key researchers in the field, including Drs. Spero Manson, Bernice Pescosolido, and Linda Cottler.

Publications:

Freedenthal, S., Stiffman, A.R. (2007) “They Might Think I Was Crazy:” Young American Indians’ Reasons for Not Seeking Help when Suicidal. Journal of Adolescent Research, 22, 58-77.

Stiffmann, A.R., Alexander-Eitzman, B., Silmere, H., Osborne, V. & Brown, E. (2007) From early to late adolescence: American Indian youths’ behavioral trajectories and their major influences. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 849-858.

Yu, M., Stiffman, A.R. (2007) Culture and Environment as Predictors of Alcohol Abuse/Dependence Symptoms in American Indian Youth. Addictive Behaviors, 32, 2253-2259.

Stiffman, A.R., Brown, E., Freedenthal, S., House, L., Ostmann, E. & Yu, M. (2007) Southwestern American Indian Urban and Reservation youth: Personal, Familial, and Environmental Strengths. Journal of Child and Family Studies, 16, 331-346.

Stiffman, A.R., Freedenthal, S., Dore, P., Ostmann, E., Osborne, V., Silmere, H. (2006) The Role of Providers in Mental Health Services Offered to American-Indian Youths. Psychiatric Services, 57, 1185-1191.

House, L.E., Stiffman, A.R., Brown, E. (2006). Unraveling Cultural Threads: A Qualitative Study of Ethnic Identity among Urban Southwestern American Indian Youth and Parents, and Elders. Journal of Child and Family Services, 15, 393-407.

Marsiglia, F.F., Nieri, T., Stiffman, A.R. (2007). HIV/AIDS Protective Factors among Urban American Indian Youths. Journal of Health Care for the Poor and Underserved, 17, 745-758

Stiffman, A.R., Brown, E., Striley, C.W., Ostmann, E., Chowa, G. (2005). Cultural and Ethical Issues Concerning Research on American Indian Youth. Ethics and Behavior, 15, 1-14.

Stiffman, A.R., Brown, E., Striley, C.W., Ostmann, E., & Chowa, G. (2005). Research solutions for cultural and human subjects issues concerning American Indian youth. Ethics and Behavior. 15(1), 1-14.

Yu, M.S., Stiffman, A.R., Freedenthal, S. (2005). Factors affecting American Indian adolescent tobacco use. Addictive Behaviors, 30, 889-904.

Freedenthal, S., Stiffman, A.R. (2004). Suicidal Behavior in Urban American Indian Adolescents: A comparison with Reservation Youth in a Southwestern State. Suicide and Life-threatening Behavior, 34, 160-171.

Stiffman, A.R., Striley, C., Brown, E., Limb, G., Ostmann, E. (2003). American Indian Youth: Who Southwestern Urban and Reservation Youth Turn to for Help with Mental Health of Addictions. Journal of Child & Family Studies, 12, 319-333.

Stiffman, A.R., Striley, C.W., Brown, E., Limb, G. & Ostmann, E. (2003). American Indian Youth: Southwestern and urban reservation youth's need for services and whom they turn to for help. Journal of Child and Family Studies, 12, 319-333.

Oral Papers at Conferences:

2003 Stiffman, A.R., Freedenthal, S., House, L. & Brown, E. Research solutions to balance data integrity and the principle of beneficence. Beyond the clinic walls. NIMH/NIDA Conference. Washington D.C.

2003 Stiffman, A.R., Brown, E. & Ostmann, E. The impact of environment, addictions, and education on American Indian youth's HIV risk behaviors. Society for Social Work Research. Washington D.C., February.

2002 Striley, C., Stiffman, A.R., Ostmann, E., & Brown, E. American Indian youth symptoms predicted by context: Traumatic events, school environment, and family issues. APHA. Philadelphia, PA, November.

2002 Stiffman, A.R., Striley, C., Brown, E., Ostmann, E., & Limb, G. Southwestern American Indian youth's mental health and use of service configurations. APHA. Philadelphia, PA, November.

2002 Stiffman, A.R., Striley, C., Brown, E., Ostmann, E., & Limb, G. American Indian youth's addictions issues and natural helping networks. APHA. Philadelphia, PA, November.

2002 Stiffmann, A.R., Striley, C., Brown, E., Limb, G., & Ostmann, E. American Indian adolescents, addictions, trauma, and HIV risk. APHA. Philadelphia, PA, November.

2002 Stiffman, A.R., Striley, C., Brown, E., Ostmann, E., & Limb, G. Southwestern American Indian Urban and Reservation Youth's Need for and Use of Service Providers. NIMH Social Work Research Conference, Bethesda, MD, June.

2002 Stiffman, A.R., Brown, E., Striley, C., Limb, G., & Ostmann, E. Amerian Indian Teens: Southwestern urban and reservation youth's need for services and whom they turn to for help. 15th Annual Research Conference, A System of Care for Children's Mental Health: Expanding the Research Base. Tampa, FL.

2002 Stiffman, A.R., Brown, E., Striley, C., Limb, G., & Ostmann, E. Research solutions for cultural and human subjects issues concerning American Indian Youth. 15th Annual Research Conference, A System of Care for Childeren's Mental Health: Expanding the Research Base. Tampa, FL.

2002 Limb, G., Brown, E., Stiffman, A.R., Striley, C., & Ostmann, E. The impact of out-of-home placement on American Indian Teens' drug use and service utilization. 15th Annual Research Conference, A System of Care for Children's Mental Health: Expanding the Research Base. Tampa, FL.

2002 Striley, C., Stiffman, A.R., Ostmann, E., & Brown, E. American Indian Teen's functioning predicts teen desire for talking about and receiving services. 15th Annual Research Conference, A System of Care for Children's Mental Health: Expanding the Research Base. Tampa, FL.

2002 Striley, C., Stiffman, A.R., & d Pescarino, R.A. Functioning predicts service access for American Indian teens. SSWR, San Diego, CA, January.

2001 Brown, E., Limb, G., Stiffman, A.R., & Striley, C. Fostering Tribal, State, and Federal Reslationships to Improve Mental Health. National Indian Health Board's 19th Annual Consumer Conference. Denver, CO, September.