Journal of Child and Family Studies

, Volume 12, Issue 3, pp 319–333 | Cite as

American Indian Youth: Who Southwestern Urban and Reservation Youth Turn to for Help with Mental Health or Addictions

  • Arlene Rubin Stiffman
  • Catherine Striley
  • Eddie Brown
  • Gordon Limb
  • Emily Ostmann


We illustrate the addictions and mental health service use of American Indian adolescents. Interviews concerning mental health need and service configurations with 401 Southwestern American Indian (AI) youth used questions from the Diagnostic Interview Schedule (DIS) and the Service Assessment for Children and Adolescents (SACA). Seventy-nine percent had mental health or addiction problems, with half meeting criteria for at least one diagnosis. One in 4 youth met criteria for drug dependence'abuse or conduct disorder, 1 in 5 for depression, and 1 in 8 for alcohol dependence'abuse. Most youth were helped by a combination of providers. Youth meeting more diagnostic criteria were increasingly likely to use service configurations with adults, nonspecialist professionals, and specialists, respectively. Regardless of disorder, youth were least likely to use configurations with traditional healers or specialists and there was little difference in rates of use between the two. The lack of services from specialist providers was potentially offset by use of an extensive range of informal adults, nonspecialist professionals, and peers. Since informal helpers, peers, and nonspecialist providers, but not specialists, are providing the bulk of services they must be given support and skills so they can function effectively.

adolescents American Indian mental health addictions services 


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  1. Achenbach, T.M. (1991). Manual for the youth self-report and 1991 profile. Burlington, VT: University of Vermont Department of Psychiatry.Google Scholar
  2. Alegria, M., Rogles, R., Freeman, D.H., Vera, M., Jimenez, A., Rios, C., & Rios, R. (1991). Patterns of mental health utilization among island Puerto Rican poor. American Journal of Public Health, 81, 875–879.Google Scholar
  3. Bachman, J.G., Wallace, J.M., O'Malley, P.M., Johnston, L.D., Kurth, C.L., & Neighbors, H.W. (1991). Racial/ethnic differences in smoking, drinking, and illicit drug use among American high school seniors. American Journal of Public Health, 81, 372–377.Google Scholar
  4. Beals, J., Piasecki, J., Nelson, S., Jones, M., Keane, E., Dauphinais, P., Red Shirt, R., Sack, W., & Manson, S.M. (1997). Psychiatric disorder among American Indian adolescents: Prevalence in Northern Plains youth. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 1252–1259.Google Scholar
  5. Bird, H.R., Shaffer, D., Fisher, P., Gould, M.S., Staghezza, B., Chen, J.Y., & Hoven, C. (1993). The Columbia Impairment Scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Research, 3, 167–176.Google Scholar
  6. Brown, E.R., Ojeda, V.D., Wyn, R., & Levan, R. (2000). Racial and ethnic disparities in access to health insurance and health care. Los Angeles: UCLA Center for Health Policy Research and The Henry J. Kaiser Family Foundation.Google Scholar
  7. Burns, B.J. (1991). Mental health service use by adolescents in the 1970s and 1980s. Journal of the American Academy of Child & Adolescent Psychiatry, 30, 144–150.Google Scholar
  8. Burns, B.J., Costello, E.J., Angold, A., Tweed, D., Stangl, D., Farmer, E.M.Z., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147–159.Google Scholar
  9. Centers for Disease Control (1996). Youth risk behavior surveillance-United States, 1995. Morbidity and Mortality Weekly Report, 45, (No. SS-4).Google Scholar
  10. Costello, E.J., Angold, A., Burns, B.J., Farmer, E.M.Z., Stangl, D.K., Erkanli, A. & Messer, S.C. (1995). Great Smoky Mountains study: 1. Use of service for mental health care. NIMH Mental Health Services Research Conference.Google Scholar
  11. Costello, E.J., Burns, B.J., Angold, A., & Leaf, P.J. (1993). How can epidemiology improve mental health services for children and adolescents? Journal of the American Academy of Child & Adolescent Psychiatry, 32, 1106–1115.Google Scholar
  12. Costello, E.J., Burns, B.J., Costello, A.J., Edelbrock, C., Dulcan, M., & Brent, D. (1988). Service utilization and psychiatric diagnosis in pediatric primary care: The role of the gatekeeper. Pediatrics, 82, 435–441.Google Scholar
  13. Costello, E.J., Edelbrock, C., Costello, A.J., Dulcan, M.K., Burns, B.J., & Brent, D. (1988). Psychopathology in pediatric primary care: The new hidden morbidity. Pediatrics, 82, 415–424.Google Scholar
  14. Costello, E.J., Farmer, E.M.Z., Angold, A., Burns, B.J., & Erkanli, A. (1997). Psychiatric Disorders among American Indian and White Youth in Appalachia: The Great Smoky Mountains Study. Americam Journal of Public Health, 87, 827–832.Google Scholar
  15. Dick, R.W., Manson, S.M., & Beals, J. (1993). Alcohol use among male and female Native American adolescents: Patterns and correlates of student drinking in a boarding school. Journal of Studies of Alcohol, 54, 172–177.Google Scholar
  16. Flisher, A.J., Kramer, R.A., Grosser, R.C., Alegria, M., Bird, H.R., Bourdon, K.H., Goodman, S.H., Greenwald, S., Horwitz, S.M., Moore, R.E., Narrow, W.E., & Hoven, C.W. (1997). Correlates of unmet need for mental health services by children and adolescents. Psychological Medicine, 27, 1145–1154.Google Scholar
  17. Gfellner, B.M., & Hundelby, J.D. (1995). Patterns of drug use among Native and white adolescents: 1990–1993. Canadian Journal of Public Health, 86, 95–97.Google Scholar
  18. Hoagwood, K. (1991). The social maladjustment exclusion in educational policy: Implications for multiagency coordination of services. Journal of the Mental Health Administation, 18, 35–42.Google Scholar
  19. Hoagwood, K., Horwitz, S.M., Stiffman, A.R., Weisz, J., Bean, D., Rae, D., Compton, W., Cottler, L., Bickman, L., & Leaf, P. (2001). Concordance between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA). Journal of Child and Family Studies, 9, 315–331.Google Scholar
  20. Hoberman, H.M. (1992). Ethnic minority status and adolescent mental health services utilization. Journal of the Mental Health Administation, 19, 246–267.Google Scholar
  21. Horwitz, S. C., Hoagwood, K., Stiffman, A.R., Summerfeld, T., Weisz, J. R., Costello, E.J., Rost, K., Bean, D.L., Cottler, L., Leaf, P.J., Roper, M., & Norquist, G. (2001). Reliability of the Services Assessment for Children and Adolescents. Psychiatric Services, 52, 1088–1094.Google Scholar
  22. Joe, J. (1991). The delivery of health care to American Indians: History, policies, and prospects. In D.E. Green & T.V. Tonnessen (Eds.). American Indians: Social Justice and Public Policy volume 1X, Ethnicity and Public Policy Series (pp. 149–179). Madison: The University of Wisconsin series.Google Scholar
  23. Landsverk, J., Madsen, J., Litrownik, A., Ganger, W., & Newton, R. (1992). Mental health problems of foster children. Presented at Health Care Response to Child Maltreatment, Children's Hospital, San Diego, California.Google Scholar
  24. Risk factor for suicide among Indian adolescents at a boarding school. Public Health Reports, 104, 609–614.Google Scholar
  25. Novins, D.K., Beals, J., Roberts, R., & Manson, S.M. (1999). Factors associated with suicidal ideation among American Indian adolescents: Does culture matter? Journal of Suicide and Life-Threatening Behavior, 29, 332–345.Google Scholar
  26. Novins, D.K., Beals, J., Sack, W.H., & Manson, S.M. (2000). Unmet needs for substance abuse and mental health services among Northern Plains American Indian adolescents. Psychiatric Services, 51, 1045–1047.Google Scholar
  27. Novins, D.K., Harman, C.P., Mitchell, C.M., & Manson, S.M. (1996). Factors associated with the receipt of alcohol treatment services among American Indian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 110–117.Google Scholar
  28. Oetting, E.R., & Beauvais, F. (1991). Orthogonal cultural identification theory: The cultural identification of minority adolescents. The International Journal of the Addictions, 25, 655–685.Google Scholar
  29. Office of Technology Assessment. (1990). Indian adolescent mental health. OTA-H-446. Washington, DC: U.S. Government Printing Office.Google Scholar
  30. Proctor, E.P., & Stiffman, A.R. (1998). Mental health treatment and service research: Background. In J.B. Williams & K. Ell (Eds.). Recent advances in mental health research: Implications for social work practice (pp. 259–286). Washington D.C.: NASW Press.Google Scholar
  31. Regier, D.A., Hirschfeld, R.M.A., Goodwin, F.K., Burke, J.D., Jr., Lazar, J.B., & Judd, L.L. (1988). The NIMH Depression Awareness, Recognition, and Treatment Program: Structure, aims, and scientific basis. American Journal of Psychiatry, 145, 1351–1357.Google Scholar
  32. Robin, R.W., Chester, B., Rasmussen, J.K., Jaranson, J.M., Goldman, D. (1997). Prevalence and characteristics of trauma and posttraumatic stress disorder in a southwestern American Indian community. American Journal of Psychiatry, 154, 1582–1588.Google Scholar
  33. Robins, L.N., & Helzer, J.E. (1994). The half-life of a structured interview: The NIMH Diagnostic Interview Schedule (DIS). Special Issue: A ten-year retrospective on the NIMH Epidemiologic Catchment Area (ECA) Program. International Journal of Methods in Psychiatry Research, 4, 95–102.Google Scholar
  34. SAS Institute Inc. (1999). SAS Procedures Guide, (Version 8). Cary, NC: SAS Institute Inc.Google Scholar
  35. Salgado De Snyder, V., Diaz-Perez, M., Maldanado, M., Bautista, E.M. (1998). Pathways to mental health services among inhabitants of a Mexican village. Health and Social Work, 23, 249–261.Google Scholar
  36. Stiffman, A.R., Horwitz, S.M., Hoagwood, K., Compton, W., Cottler, L., Narrow, W., & Weisz, J. (2000). Adult and child reports of mental health services in the Service Assessment for Children and Adolescents (SACA). Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1–8.Google Scholar
  37. Stiffman A.R., Chen, Y.W., Elze, D., Doré, P., & Cheng, L.C. (1997). Adolescents' and providers' perspectives on the need for and use of mental health services. Journal of Adolescent Health, 21, 335–342.Google Scholar
  38. Stiffman, A.R., Hadley-Ives, E., Dore, P., Polgar, M., Horvath, V.E., Striley, C., Elze, D. (2000). Youths' access to mental health services: The role of providers' training, resource connectivity, and assessment of need. Mental Health Services Research, 2, 141–154.Google Scholar
  39. Stiffman, A.R., Earls, F., Robins, L.N., & Jung, K.G. (1988). Problems and help-seeking in high-risk adolescent patients of health clinics. Journal of Adolescent Health, 9, 305–309.Google Scholar
  40. Swinomish Tribal Mental Health Project (1991). A gathering of wisdoms, Tribal mental health: A cultural perspective. Mt. Vernon, Washington: Veda Vanguard.Google Scholar
  41. Tam, T.W., Schmidt, L., & Weisner, C. (1996). Patterns in the institutional encounters of problem drinkers in a community human services network. Addiction, 91, 657–669.Google Scholar
  42. U.S. Census Bureau (2001). Overview of race and Hispanic origin (Census 2000 Brief No. C2KBR/01–1). Washington, DC: Author.Google Scholar
  43. U.S. Department of Health and Human Services. (2001). Mental Health: Culture, Race, and Ethnicity–A supplement to Mental Health: a Report of the Surgeon General. Chapter on: Mental Health Care for American Indians and Alaskan Natives. Rockville, MD: USDH&HS, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, 79–104.Google Scholar
  44. Vine Jr.,D. (1985). The Evolution of Federal Indian Policy Making. American Indian Policy in the Twentieth Century, Norman: University of Oklahoma Press.Google Scholar
  45. Walker, R.D., Lambert, M.D., Walker, P.S., & Kivlahan, D.R. (1993). Treatment implications of comorbid psychopathology in American Indians and Alaska Natives. Culture, Medicine and Psychiatry, 16, 555–572.Google Scholar
  46. Wellever, A., Hill, G., & Casey, M. (1998). Commentary: Medicare Reform Issues affecting the Indian Health Care System. American Journal of Public Heath, 88, 193–195.Google Scholar
  47. Wells, K.B., Golding, J.M., Hough, R.I., Burnam, N.A., & Karno, M. (1988). Factors affecting the probability of youths of general and medical health and social/community services for Mexican Americans and non-Hispanic Whites. Medical Care, 26, 441–452.Google Scholar
  48. Westermeyer, J., Neider, J., & Westermeyer, M. (1993). Substance use and other psychiatric disorders among 100 American Indian patients. Culture, Medicine and Psychiatry, 16, 519–529.Google Scholar
  49. Zahner, G.E.P., Pawelkiewicz, W., DeFrancesco, J.J., & Adnopoz, J. (1992). Children's mental health service needs and utilization patterns in an urban community: An epidemiological assessment. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 951–960.Google Scholar

Copyright information

© Human Sciences Press, Inc. 2003

Authors and Affiliations

  • Arlene Rubin Stiffman
    • 1
  • Catherine Striley
    • 2
  • Eddie Brown
    • 3
  • Gordon Limb
    • 4
  • Emily Ostmann
    • 5
  1. 1.George Warren Brown School of Social WorkWashington UniversitySt. Louis
  2. 2.Department of PsychiatryWashington UniversitySt. Louis
  3. 3.Buder Center for American Indian Studies, George Warren Brown School of Social WorkWashington UniversitySt. Louis
  4. 4.George Warren Brown School of Social WorkWashington UniversitySt. Louis
  5. 5.George Warren Brown School of Social WorkWashington UniversitySt. Louis

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