Arlene Rubin Stiffman

Bio: Arlene Rubin Stiffman is an academic researcher from Washington University in St. Louis. The author has contributed to research in topics: Mental health & Poison control. The author has an hindex of 30, co-authored 63 publications receiving 3145 citations. Previous affiliations of Arlene Rubin Stiffman include University of Washington & Mental Health Services.

Building a model to understand youth service access: the gateway provider model.

Abstract: Enhancing the functioning of parents, teachers, juvenile justice authorities, and other health and mental heal professionals who direct children and adolescents to services is a major mental health services concern. The Gateway Provider Model is an elaborated testable subset of the Network-Episode Model (NEM; B. A. Pescosolido & C. A. Boyer, 1999) that synthesizes it with Decision (D. H. Gustafson, et al., 1999) and organizational theory (C. Glisson, 2002; C. Glisson & L. James, 1992, 2002). The Gateway Provider Model focuses on central influences that affect youth’s access to treatment, i.e., the individual who first identifies a problem and sends a youth to treatment (the “gateway provider”); and the need those individuals have for information on youth problems and relevant potential resources. Preliminary studies by the authors and other applicable studies (D. Carise & O. Gurel, 2003) show that providers’ perception of need, and their knowledge of resources, and their environment are related to the decision to offer or refer to services, supporting key aspects of the Model.

The Service Assessment for Children and Adolescents (SACA): Adult and child reports

Abstract: Objective To describe differences in parent-child responses to the Service Assessment for Children and Adolescents (SACA). Method Studies were done at UCLA and Washington University based on service-using and community subjects drawn from community households or public school student lists, respectively. Results are presented for 145 adult-youth pairs in which the youth was 11 or older. Results The SACA adult-youth correspondence for lifetime use of any services, inpatient services, outpatient services, and school services ranged from fair to excellent (κ = 0.43-0.86, with most at 0.61 or greater). Similarly, the SACA showed a good to excellent correspondence for services that had been used in the preceding year (κ = 0.45-0.77, with most greater than 0.50). The parent-youth correspondence for use of specific service settings in the above generic categories ranged from poor to excellent (κ = 0.25-0.83, with half at 0.50 or greater). Conclusions The SACA has better adult-youth correspondence than any service use questionnaire with published data, indicating that both adult and youth reports are not needed for all research on mental health services. This is especially encouraging news for researchers working with high-risk youth populations, in which a parent figure is often not available.

Reliability of the Services Assessment for Children and Adolescents

Abstract: Objective: This study examined the test-retest reliability of a new instrument, the Services Assessment for Children and Adolescents (SACA), for children’s use of mental health services. Methods: A cross-sectional survey was undertaken at two sites. The St. Louis site used a volunteer sample recruited from mental health clinics and local schools. The Ventura County, California, site used a double-blind, community-based sample seeded with cases of service-using children. Participating families completed the SACA and were retested within four to 14 days. The reliability of service use items was calculated with use of the kappa statistic. Results: The SACA– Parent Version had excellent test-retest reliability for both lifetime service use and previous 12-month use. The SACA also had good to excellent reliability when administered to children aged 11 and older for lifetime and 12-month use. Reliability figures for children aged nine and ten years were considerably lower for lifetime and 12-month use. The younger children’s responses suggested that they were confused about some questions. Conclusions: This study demonstrates that parents and older children can reliably report use of mental health services by using the SACA. The SACA can be used to collect currently unavailable information about use of mental health services. (Psychiatric Services 52:1088–1094, 2001)

Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

Abstract: The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global “any use” service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.

Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity.

Abstract: Etude de la coherence entre differentes sources (269 echantillons utilisees dans 119 etudes) concernant les evaluations des problemes affectifs et comportementaux d'enfants et d'adolescents âges de 1 1/2 a 19 ans

ASSESSING "NEIGHBORHOOD EFFECTS": Social Processes and New Directions in Research

Abstract: ▪ Abstract This paper assesses and synthesizes the cumulative results of a new “neighborhood-effects” literature that examines social processes related to problem behaviors and health-related outcomes. Our review identified over 40 relevant studies published in peer-reviewed journals from the mid-1990s to 2001, the take-off point for an increasing level of interest in neighborhood effects. Moving beyond traditional characteristics such as concentrated poverty, we evaluate the salience of social-interactional and institutional mechanisms hypothesized to account for neighborhood-level variations in a variety of phenomena (e.g., delinquency, violence, depression, high-risk behavior), especially among adolescents. We highlight neighborhood ties, social control, mutual trust, institutional resources, disorder, and routine activity patterns. We also discuss a set of thorny methodological problems that plague the study of neighborhood effects, with special attention to selection bias. We conclude with promising ...

Risky Families: Family Social Environments and the Mental and Physical Health of Offspring

Abstract: Risky families are characterized by conflict and aggression and by relationships that are cold, unsupportive, and neglectful. These family characteristics create vulnerabilities and/or interact with genetically based vulnerabilities in offspring that produce disruptions in psychosocial functioning (specifically emotion processing and social competence), disruptions in stress-responsive biological regulatory systems, including sympathetic-adrenomedullary and hypothalamic-pituitary-adrenocortical functioning, and poor health behaviors, especially substance abuse. This integrated biobehavioral profile leads to consequent accumulating risk for mental health disorders, major chronic diseases, and early mortality. We conclude that childhood family environments represent vital links for understanding mental and physical health across the life span.

Neighborhoods and health.

Abstract: Features of neighborhoods or residential environments may affect health and contribute to social and race/ethnic inequalities in health. The study of neighborhood health effects has grown exponentially over the past 15 years. This chapter summarizes key work in this area with a particular focus on chronic disease outcomes (specifically obesity and related risk factors) and mental health (specifically depression and depressive symptoms). Empirical work is classified into two main eras: studies that use census proxies and studies that directly measure neighborhood attributes using a variety of approaches. Key conceptual and methodological challenges in studying neighborhood health effects are reviewed. Existing gaps in knowledge and promising new directions in the field are highlighted.