Research That Matters (January 17 - 20, 2008)

Purpose: This study examined the social and clinical factors associated with psychiatric emergency services (PES) use among African American youth, a group that disproportionately uses more PES services than community-based services. We examined social and clinical factors associated with arrival status (e.g. involuntary versus voluntary) to PES and civil commitment decisions among a sample of African American youth to further elucidate their help-seeking patterns and entrée into care. Community-based mental health treatment might be accessed earlier in the illness careers of youth if we better understood what mental health problems precipitate their entrée into PES.

Methods: This study was a secondary data analysis of an inner-city psychiatric emergency service center in Philadelphia, PA. One thousand, six hundred and twenty one African American youths under 24 years of age who arrived at the emergency service center were included in the study. Patient records were reviewed to determine social and clinical predictors of arrival status (e.g. involuntary admission vs. voluntary admission) and case disposition among youth who were involuntarily admitted (e.g. disposition upheld vs. dismissed). Social and clinical predictors included: age, insurance status, DSM diagnosis, substance abuse involvement, suicidality, GAF scores and time of arrival. Information was gathered from the patient records of 1,621 African American youth who accessed the psychiatric emergency service unit between October 1, 2001 and September 30, 2002. Multivariate logistic regression was used to examine the factors associated with arrival status and civil commitment decision among the subset of the sample for which there was an official petition for civil commitment. In the multivariate model examining commitment decision, we controlled for the independent influence of sociodemographic and clinical factors. Age and GAF scores were treated as continuous variables to improve the model fit.

Results: Low income youth with behavior disorders were less likely to arrive voluntarily to PES. Older youth with serious impairment in functioning were more likely to have their involuntarily admission upheld. The multivariate logistic regression of social and clinical factors predicting voluntary arrival status (c² = 241.19, df = 14; p < .001) and predicting whether an involuntary commitment was upheld (c² = 354.53, df = 12; p < .001) fit the data well. Medical insurance, suicidality, DSM diagnosis, substance involvement, GAF scores, and time of day the youth arrived to PES were predictors of voluntary arrival. Only two social and clinical factors were significant predictors of the decision to uphold an involuntary commitment: age and GAF scores.

Implications: Limited information is available on the PES experiences (e.g. arrival status, case disposition) of urban, African American youth. If PES remains the main entrée point into care for this group, social workers need to be more knowledgeable of the factors that underlie youths' service use experiences in PES, in particular, the social and clinical factors related to their case disposition. This study underscores the importance of understanding social and clinical factors associated with arrival status and civil commitment among African American youth and discusses implications for social work practice in this sector.