Saturday, 15 January 2005 - 10:00 AM

This presentation is part of: Sexual Health and Addiction Services in Adolescents

The Role of Professional Providers, Informal Providers, and Traditional Healers in Services for American Indian Youth

Purpose. This paper examines the central influences that affect youth’s access to treatment for addictions or comorbid mental health problems: the individual who first identifies a problem and sends a youth to treatment; and the need those individuals have for information on youth problems and relevant potential resources. The analyses are based on the Gateway Provider Model (Stiffman, Pescosolido & Cabasso, In Press), that examines the role of providers who link individuals with services as well as provide specialty services.

Methods. A sample of 401 American Indian youth (about 200 from an urban area and 200 from a reservation area, aged 12 to 19) was first interviewed in person in 2001 (Stiffman, Striley, Brown, Limb, & Ostmann, 2003). The youth were asked to name those individuals who helped them with their addictions or mental health problems in the last year. The youth named professional providers (social workers, teachers, counselors, physicians, etc), informal providers (family and friends), and traditional healers. The study then interviewed 190 providers, who offered services to 212 youth, and merged that data with the youth data.

Results. Structural Equation Modeling revealed that referral to, recommendation of, or direct provision of services was influenced largely by gateway provider knowledge of the youth and of service resources. In all, 42% of the variance in provider actions was determined by provider assessment of youths' addictions or mental health problems (.36), provider perception of youth environment (.28), and provider resource knowledge (.27). In turn, 51% of the variance in provider perception of youth problems was influenced by youth report of addictions or mental health problems (.37), inservice training (-.15, indicating that those without inservice training (informal providers and traditional healer) might have the highest levels of perception of the youth’s problems), and provider perception of the youth’s environment (.59). A similar 51% of the variance in provider perception of youth environment was influenced by youth report of their mental health or addictions problems, but not by youth report of their environment. Twenty-eight percent of the variance in provider resource knowledge was influenced by inservice training (.47). Youth report of their own addictions or mental health problems did not contribute directly to variance in services. The values of all of the SEM indices for our model were high, with the Adjusted Goodness of Fit Index (AGFI) equalling .99 ( N=123 CHISQ=14.6 (DF=10), p=.15, RMSEA =.061, 90% CI={., .124}) .

Implications. The results demonstrate the pivotal role of gateway providers in addictions and mental health services. The provider’s assessment of the youth’s mental health problems, rather than the youth’s self-reported problems, is related to service provision. Providers may be more likely to both identify youth’s problems and refer youth to services when two pieces of information are in place: 1) knowledge of community resources available to youth; and 2) knowledge of assessment. (Funded by NIDA Grant # 1 RO1 DA13227-01).

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