Addressing Inequities in Access to Mental Healthcare: A Policy Analysis of Community Mental Health Systems Serving Minoritized Populations in North Carolina.

Racial and ethnic minoritized uninsured populations in the United States face the greatest barriers to accessing mental healthcare. Historically, systems of care in the U.S. were set up using inadequate evidence at the federal, state, and local levels, driving inequities in access to quality care for minoritized populations. These inequities are most evident in community-based mental health services, which are partially or fully funded by federal programs and predominantly serve historically minoritized groups. In this descriptive policy analysis, we outline the history of federal legislative policies that have dictated community mental health systems and how these policies were implemented in North Carolina, which has a high percentage of uninsured communities of color. Several gaps between laws passed in the last 60 years and research on improving inequities in access to mental health services are discussed. Recommendations to expand/fix these policies include funding accurate data collection and implementation methods such as electronic health record (EHR) systems to ensure policies are informed by extensive data, implementation of evidence-informed and culturally sensitive interventions, and prioritizing preventative services that move past traditional models of mental healthcare.

Sex offender registration and notification act with adolescents adjudicated for illegal sexual behavior: a therapeutic jurisprudence perspective.

Adolescents adjudicated for illegal sexual behavior (AISB) are subjected to the same Sex Offender Registration and Notification Act (SORNA) policies as adults with sexual offense histories despite current research documenting their relatively low likelihood of recidivism. Therapeutic jurisprudence is a framework which suggests the law should value psychological well-being and strive to avoid imposing anti-therapeutic consequences. The purpose of this article is to analyze the use of SORNA policies with AISB from a therapeutic jurisprudence perspective. Given the current literature documenting the collateral consequences of SORNA on AISB and their families and the lack of efficacy in reducing recidivism, we argue SORNA should not be applied to children and adolescents. We conclude with a discussion of future directions for the juvenile justice system and public policy reform.

Adapting assessment processes to consider cultural mistrust in forensic practices: An example with the MMPI instruments.

OBJECTIVE: Our first goal in this study was to identify cultural mistrust critical items (CMCIs) on two versions of the Minnesota Multiphasic Personality Inventory (MMPI)-the MMPI-Second Edition-Restructured Form (MMPI-2-RF) and MMPI-Third Edition (MMPI-3)-that might be endorsed by people of color because of cultural mistrust rather than clinical paranoia. Our second goal was to determine whether CMCIs and items on the MMPI-2-RF/MMPI-3 Ideas of Persecution scale (Restructured Clinical Scale 6 [RC6]) were endorsed at different rates across cultural groups in a nonclinical college sample and a forensic inpatient sample. HYPOTHESES: Our primary hypothesis was that expert raters would reliably identify a subset of MMPI-2-RF and MMPI-3 items as reflective of cultural mistrust. Black college students would endorse the highest level of CMCIs, followed by Latina/o students, and then White students. We hypothesized that the same pattern of findings would occur in forensic inpatients but that the differences would be attenuated because of the high base rate of psychiatric symptomatology and the nature of the forensic assessment setting. METHOD: Three Black female and three Black male psychologists rated the degree to which each item on the MMPI-2-RF and MMPI-3 reflected cultural mistrust. Black (n = 90), Latina/o (n = 83), and White (n = 100) college students were compared on CMCIs and on MMPI-2-RF/MMPI-3 RC6 item endorsement. The same comparisons were made among Black (n = 221), Latina/o (n = 142), and White (n = 483) forensic inpatients who completed the MMPI-2-RF. RESULTS: Black college students endorsed the highest levels of cultural mistrust, followed by Latina/o students, and then White students, resulting in small-to-medium effect sizes (Hedges's gs = 0.14-0.52). Although we observed some item-level differences in forensic patients, the overall pattern of item endorsement did not significantly differ in this group. CONCLUSIONS: There are multiple reasons for the reporting of clinical paranoia and cultural mistrust in forensic assessment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A roadmap for preventing and responding to trauma: Practical guidance for advancing community-engaged research.

OBJECTIVE: Community-engaged research (CEnR) is an approach to inquiry that centers scientist-community partnerships characterized by mutuality and reciprocity, and is well-aligned with trauma-informed principles, such as trustworthiness, transparency, and fostering empowerment. METHOD: The current paper considers definitions and applications of CEnR, highlighting examples from the trauma literature, from the formulation of research questions to the dissemination of research findings. CONCLUSION: To realize CEnR's promise to contribute to innovation, scientific understanding, and increased impact in the trauma field will require a shift in training and institutions. Fortunately, a growing interest in advocacy, public psychology, and diversity, equity, and inclusion presents an opportunity for synergy. Practical guidance is offered for supporting CEnR by preparing students, investing in faculty, and building infrastructure. Clinical Impact Statement: Community-engaged research (CEnR) focuses on equitable scientist-community partnerships in research, and shares principles with trauma-informed work. By prioritizing community collaboration, CEnR has the potential to lead to innovation, scientific understanding, and increased impact in the trauma field. For example, CEnR approaches emphasize dissemination to public audiences, which could help educate the public and policymakers about trauma and its impact. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Simulated judicial decision-making for African and European American adolescents with illegal sexual behavior: The impact of medical data and victim race/ethnicity.

The perceived importance of victim and defendant race/ethnicity and medical evidence in child sexual abuse cases has been recognized separately in the literature. However, few studies have considered these factors simultaneously. Within a sample of 880 college students, an interaction effect was tested between the presence of medical evidence and the race/ethnicity of a juvenile defendant and victim using child sexual abuse case vignettes. The main effects of medical evidence and the race of the defendant were observed. Medical evidence and race of victim influenced victim believability such that medical evidence was more impactful for cases with African American victims. Further, there were interactions between the race of the defendant and the race of the victim in adult versus juvenile court decisions, sex offender registration and notification requirements, and length of sex offender registration and notification. Interracial sexual offending was associated with substantially higher punishment than intraracial sexual offending. Accordingly, several important implications for court-level decision-making processes are explored.

Competency Restoration for Adult Defendants in Different Treatment Environments.

The optimization of trial competency restoration is a topic of growing interest and controversy in the fields of forensics, psychology, criminal law, and public policy. Research has established that adult defendants who have severe psychotic disorders and cognitive impairments are more likely than defendants without these conditions to be found incompetent to stand trial and are less likely to be restored to competency thereafter. Research has also identified some of the benefits of attempting restoration in hospitals, jails, or outpatient settings for defendants with different diagnoses or levels of cognitive functioning. Rates of restoration, length of stay necessary to achieve restoration, and, in some cases, how quickly defendants are found non-restorable are primary indicators of positive outcome. We sought to review the extant literature on competency restoration, with the goals of identifying implications for current practice and generating inquiries for future research. We found that there are significant advantages and disadvantages of attempting restoration in a hospital, jail, or outpatient setting on rates of restoration, length of stay necessary to achieve restoration, or length of time necessary to determine non-restorability, while controlling for several relevant factors (e.g., diagnosis, cognitive limitations).

Race and Victim Age Matter: Sexual Behaviors and Experiences Among Confined African American and European American Youth With Sexual and Nonsexual Offenses.

Previous research has found differences in sexual behavior and types of sexual offending by offense category and racial/ethnic group. The present study examined effects of offense category, victim age, and race/ethnicity on sexual behavior. Data from 561 confined adolescents adjudicated for illegal sexual behavior (AISBs) and adolescents adjudicated for illegal nonsexual behavior (AINBs) were included in the present study. A hierarchical multinomial logistic regression was run to test whether sexual experiences and behaviors differentially predicted AINBs, AISBs with child victims, and AISBs with peer/adult victims. Results supported the utility of distinguishing AISBs by victim age. Comparisons between AISBs and AINBs indicated AISBs had more sexual abuse and were more sexually restricted, whereas AINBs reported more sexual behavior, reflecting a finding potentially mirroring sexual development, sexual experiences, and caregiver approaches to discussing sexuality. Over 60% of AINBs and 30% of AISBs reported behaviors that could be classified as distribution of child pornography. Within the group of AISBs, select racial/ethnic group differences emerged such that European American participants were more likely to have had intrafamilial sexual experiences and were far less likely to have had vaginal intercourse than African American AISBs. Future directions and implications regarding policies related to sexual education and sexting are discussed.

Childhood Sexual Abuse in Adolescents Adjudicated for Sexual Offenses: Mental Health Consequences and Sexual Offending Behaviors.

Most studies on the mental health consequences of childhood sexual abuse (CSA) focus predominantly on CSA survivors who do not commit sexual offenses. The current study examined the effects of CSA on 498 male adolescents adjudicated for sexual offenses who represent the small portion of CSA survivors who engage in sexual offenses. The prevalence of internalizing symptoms, parental attachment difficulties, specific sexual offending behaviors, and risk for sexually offending were compared among participants with and without a history of CSA. Results indicated that participants with a history of CSA were more likely to be diagnosed with major depression and posttraumatic stress disorder than those who did not report a history of CSA. A history of CSA was also positively correlated with risk for sexually offending and with specific offense patterns and consensual sexual behaviors. No significant differences emerged on parental attachment difficulties. These results highlight that adolescents adjudicated for sexual offenses with a history of CSA present with differences in sexual and psychological functioning as well as markedly different offending patterns when compared with those without a CSA history. Clinical implications and future directions are discussed.

From Family Violence Exposure to Violent Offending: Examining Effects of Race and Mental Health in a Moderated Mediation Model Among Confined Male Juveniles.

Depression, substance use, and impulsivity have been linked to family violence exposure and to the development of violent offending during adolescence. Additionally, the indirect effects associated with these factors may not generalize across different racial/ethnic adolescent populations. The present study tested whether race/ethnicity moderated the mediated relationship between family violence exposure and violent offending, with depression, substance use, and impulsivity as mediators. A sample of 1,359 male adolescents was obtained from a juvenile correctional program. Between-racial/ethnic group comparisons were generally consistent with previous findings. The overall moderated mediation model was significant in predicting violence for both racial/ethnic groups. Different factors influenced violent offending among African Americans and European Americans in the tested model. Furthermore, race/ethnicity moderated the relationship between family violence exposure and impulsivity and substance use. Implications and future directions resolving issues are discussed concerning whether race/ethnicity should be included as a moderator in models of violence.

The Effects of Polyvictimization and Quality of Caregiver Attachment on Disclosure of Illegal Sexual Behavior.

The current study examined the relationship among self-disclosure of illegal sexual behaviors and two conceptually relevant constructs in psychotherapy: childhood polyvictimization (i.e., cumulative types of victimization experienced during childhood) and caregiver attachment. Participants consisted of 63 adolescent males participating in mandated treatment for illegal sexual behavior. Childhood polyvictimization and caregiver attachment were expected to predict self-disclosure of illegal sexual behaviors. Quality of caregiver attachment was also expected to mediate the relationship between polyvictimization and disclosure. Consistent with our main hypothesis, results indicate that quality of caregiver attachment mediated the relationship between childhood polyvictimization and self-disclosure of illegal sexual behaviors in psychotherapy. The current findings highlight the impact of polyvictimization on important therapeutic processes as well as the importance of assessing for multiple types of victimization in adolescents who engage in illegal sexual behavior. Further clinical implications regarding the use of trauma-informed approaches during sex offender treatment are discussed.

Judicial Decision-Making and Juvenile Offenders: Effects of Medical Evidence and Victim Age.

A growing body of evidence suggests that jurors place greater weight on DNA or other types of forensic evidence than non-forensic evidence (Cole & Dioso-Villa, 2009). For cases involving child sexual abuse, certain types of evidence, including forensic medical evidence, may be viewed as more important or indicative of abuse than other types of evidence, such as victim statements or disclosure. The present study evaluated perceptions of juvenile offenders and victim credibility across four vignettes that systematically manipulated variables related to victim age and physical indicators of abuse. A sample of 636 participants read vignettes and answered questions pertaining to the vignette. Participants also provided demographic information and responded to a series of items assessing participants' judicial decision-making strategies and outcomes. Broadly, the presence of medical evidence significantly influenced participants' decision-making across a variety of variables, including verdict outcome, verdict confidence, confidence that the victim was truthful, and determinations involving sex offender registration and notification requirements. The influence of medical evidence and victim age on perceptions and sentencing of juvenile sex offenders across these and additional outcome variables will be discussed.

The Neuropsychology of Adolescent Sexual Offending: Testing an Executive Dysfunction Hypothesis.

Although executive dysfunctions are commonly hypothesized to contribute to sexual deviance or aggression, evidence of this relationship is scarce and its specificity is unproven, especially among adolescents. The objective of this study was to compare the executive functioning (EF) of adolescents with sexual offense convictions (ASOC) to that of non-sex-delinquents (NSD). A secondary goal was to assess the relationship among specific sexual offense characteristics (i.e., victim age), history of childhood sexual abuse (CSA), and EF. It was hypothesized that as a group, ASOC would present similar EF profiles as NSD. It was further hypothesized that ASOC with child victims would present significantly higher rates of CSA and more severe impairment of EF than ASOC with peer-aged or older victims and NSD. A total of 183 male adolescents (127 ASOC and 56 NSD) were interviewed to collect demographic information, sexual development history, history of CSA, an assessment of living conditions, and history of delinquency and sexual offending. Participants were administered the Delis-Kaplan Executive Functioning System and the Hare Psychopathy Checklist-Youth Version. In accord with the first hypothesis, ASOC and NSD presented similar EF scores, well below normative values. Thus, EF deficits may not characterize the profiles of adolescents with sexual behavior problems. Contrarily to our second hypothesis, however, offending against children and or experiencing CSA were not associated with poorer EF performance. On the contrary, ASOC with child victims obtained significantly higher scores on measures of higher order EF than both ASOC with peer-aged or older victims and NSD. Implications of these results and future directions are discussed.

Childhood victimization, poly-victimization, and adjustment to college in women.

This study examines the relationships among poly-victimization (i.e., high cumulative levels of victimization), six aggregate categories of childhood victimization (property crime, physical assault, peer and sibling, witnessed and indirect, sexual, child maltreatment), and college adjustment in females. This study first examines the relative contributions of poly-victimization and individual categories of childhood victimization in predicting college adjustment. The study then examines whether poly-victimization contributes any unique variance, beyond that accounted for by the combination of all six aggregate categories. Regression analyses reveal that a) poly-victimization accounts for a significant proportion of variability in scores for college adjustment, beyond that accounted for by any of the six categories of childhood victimization alone, and b) the categories of childhood victimization contribute little to no variability beyond that accounted for by poly-victimization. Furthermore, poly-victimization accounts for a significant proportion of variability in college adjustment, beyond that already accounted for by the simultaneous entry of all six categories as predictor variables. Finally, although victimization does not predict GPA, it predicts other domains of college adjustment. Results suggest that counselors working with college students should a) assess multiple categories of victimization and poly-victimization, and b) evaluate clients' adjustment to college across multiple domains (e.g., academic, social, interpersonal).

Polyvictimization, childhood victimization, and psychological distress in college women.

Two studies examined the relationships among polyvictimization (i.e., high cumulative levels of victimization), six categories of childhood victimization (i.e., property crime, physical assault, peer/sibling, witnessed/indirect, sexual, and child maltreatment), and current psychological symptomatology in college females. Results indicated that exposure to multiple types of childhood victimization is common. Regression analyses revealed that polyvictimization accounted for a significant proportion of variability in scores for psychological distress beyond that accounted for by any victimization category alone. Moreover, the six categories separately accounted for little to no variability beyond that accounted for by polyvictimization. Finally, polyvictimization accounted for a significant proportion of variability in scores for psychological distress, beyond that already accounted for through the simultaneous entry of all six categories of victimization. Findings reiterate the importance for clinicians and researchers to comprehensively assess multiple categories of childhood victimization and polyvictimization and provide preliminary evidence that the total number of lifetime victimizations is at least as important, if not more important, than individual categories of victimization in predicting psychological distress.