Matthew Aalsma

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https://hdl.handle.net/1805/6681

Health Care Access and Utilization by Youth in Juvenile Justice

Youth involved in the juvenile justice system are known to have significant medical and mental health difficulties. Matt Aalsma is concerned about the large number of youth in the juvenile justice system who are minorities and are impoverished. Dr. Aalsma is researching ways to link these youth to the medical and mental health care they need for successful reentry into community life. To help youth get connected to needed services, a medical and mental health care screening program is being tested at the Indianapolis Juvenile Detention Center. This project is funded through a federal grant from the Maternal and Child Health Bureau.

Successful practices developed here in Indiana can have a positive impact on youth in juvenile justice systems across the country. Professor Aalsma’s research seeks to improve the lives of youth in the juvenile justice system as well as their chances for successful transition to community life.

Dr. Aalsma’s project exploring how to link youth in the juvenile justice system to needed medical and mental health care is another example of how IUPUI's faculty members are TRANSLATING their RESEARCH INTO PRACTICE.

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Now showing 1 - 10 of 61

Sex-specific frontal-striatal connectivity differences among adolescents with externalizing disorders
(Elsevier, 2021) Chai, Ya; Chimelis-Santiago, José R.; Bixler, Kristy A.; Aalsma, Matthew; Yu, Meichen; Hulvershorn, Leslie A.; Psychiatry, School of Medicine
Background: Sex-specific neurobiological underpinnings of impulsivity in youth with externalizing disorders have not been well studied. The only report of functional connectivity (FC) findings in this area demonstrated sex differences in fronto-subcortical connectivity in youth with attention-deficit/hyperactivity disorder (ADHD). Methods: The current study used functional magnetic resonance imaging(fMRI) to examine sex differences in resting-state seed-based FC, self-rated impulsivity, and their interactions in 11-12-year-old boys (n = 43) and girls (n = 43) with externalizing disorders. Generalized linear models controlling for pubertal development were used. Seeds were chosen in the ventral striatum, medial prefrontal cortex, middle frontal gyrus and amygdala. Results: Impulsivity scores were greater in boys than girls (p < 0.05). Boys showed greater positive connectivity within a ventromedial prefrontal-ventral striatal network. In addition, boys demonstrated weaker connectivity than girls within two medial-lateral prefrontal cortical networks. However, only boys showed greater medial-lateral prefrontal connectivity correlated with greater impulsivity. Conclusions: The findings provide evidence supporting sex differences in both ventral striatal-ventromedial prefrontal and medial-lateral prefrontal functional networks in youth with externalizing disorders. These important networks are thought to be implicated in impulse control. Medial-lateral prefrontal connectivity may represent a male-specific biomarker of impulsivity.
Youth Involved in the Justice System: Emergency Department Screening and Health Promotion
(Elsevier, 2021-09) Magee, Lauren A.; Aalsma, Matthew C.; School of Public and Environmental Affairs
Rates of Tobacco Use Disorder, Pharmacologic Treatment, and Associated Mental Health Disorders in a Medicaid Claim Review Among Youth in Indiana, USA
(Sage, 2022) McBrayer, Kimberly; Ouyang, Fangqian; Adams, Zachary; Hulvershorn, Leslie; Aalsma, Matthew C.; Pediatrics, School of Medicine
Purpose This study delineates a number of Medicaid youth with tobacco use disorder (TUD), prescribing habits for treatment, and associated externalizing disorders. Methods Youth Medicaid claims from 2007-2017 processed in a large Midwestern city were analyzed for a diagnosis of TUD, related pharmacotherapy, and externalizing mental health and substance use disorders. Results Claims connected 6541 patients with 42 890 visits. Mean age was 16.4 with 40% female. 1232 of the 6541 charts contained a TUD diagnosis equating to 1848 visits. A comorbid diagnosis of ADHD, cannabis use, and conduct disorder were more common in males (3.9% vs 1.3% in females; 3.4% vs .8%; and 2.8% vs .8%; P < .05). 808 scripts were provided to 152 of the 1232 youths, with 4.7% of those scripts a nicotine replacement product. Conclusions Pharmacotherapy is underutilized in this Medicaid claims data set. Certain externalizing factors were associated with males with TUD more than females.
Do Adolescents Consider Mind-Body Skills Groups an Acceptable Treatment for Depression? Results from a Pilot Study
(BMC, 2021) Cunningham, Lindsey D.; Salgado, Eduardo F.; Aalsma, Matthew C.; Garabrant, Jennifer M.; Staples, Julie K.; Gordon, James S.; Salyers, Michelle P.; Psychology, School of Science
Background Mind-Body Skills Groups (MBSGs) have shown promise in reducing adolescent depression symptoms; however, little is known about adolescents’ perspectives on this treatment. The objective of this study was to understand the acceptability of a new treatment for depressed adolescents in primary care settings. Methods Adolescents participating in a 10-week MBSG treatment were interviewed to understand their perspectives on the acceptability and effectiveness of the treatment. Interviews were collected at post-intervention and at a 3-month follow-up visit. Results A total of 39 adolescents completed both the post-intervention and 3-month follow-up interview. At post-intervention and follow-up, 84% of adolescents stated the MBSGs helped them. When asked how the MBSGs helped them, 3 areas were identified: learning new MBSG activities and skills, social connection with others within the group, and outcomes related to the group. Many adolescents reported no concerns with the MBSGs (49% at post- intervention; 62% at follow-up). Those with concerns identified certain activities as not being useful, wanting the group to be longer, and the time of group (after school) being inconvenient. Most adolescents reported that their life had changed because of the group (72% at post-intervention; 61% at follow-up), and when asked how, common responses included feeling less isolated and more hopeful. Conclusions Adolescents found the MBSGs to be helpful and acceptable as a treatment option for depression in primary care. Given the strong emphasis on treatment preference autonomy and the social activities within the group, MBSGs appear well-suited for this age group.
Mental health outcomes from direct and indirect exposure to firearm violence: A cohort study of nonfatal shooting survivors and family members
(Elsevier, 2022-06-30) Magee, Lauren A.; Aalsma, Matthew; Fortenberry, J. Dennis; Gharbi, Sami; Wiehe, Sarah
Background: Firearm violence is a public health crisis in the US. Beyond the survivor, firearm violence also impacts family members and communities of firearm violence survivors. Despite the known health inequities that exist among nonfatal shooting survivors, little research has focused on the mental health needs of family members of nonfatal shootings survivors. Methods: Police and Medicaid claims data linked at the individual level between January 1, 2007 – December 31, 2016 in Indianapolis, Indiana. The Medicaid case number was used to identify nonfatal shooting survivors and family members. Differences in mental health prevalence and clinical care utilization were examined in the 12-months preceding and following an index nonfatal shooting for both survivors and family members. Results were stratified by age. Results: Mental health prevalence rates increased by nearly three percent for family members of nonfatal shooting survivors in the 12-months following a nonfatal shooting, compared to the preinjury period. Among youth with a new mental health diagnosis over half were family members and no differences were observed in mental health conditions between survivors and family members. Conclusions: Findings indicate a need for improved trauma informed services and connection to mental health care for both youth survivors and family members of nonfatal shootings.
How can healthcare professionals provide guidance and support to parents of adolescents? Results from a primary care-based study
(BMC, 2021-03-20) Jones, Lindsey D.; Grout, Randall W.; Gilbert, Amy L.; Wilkinson, Tracey A.; Garbuz, Tamila; Downs, Stephen M.; Aalsma, Matthew C.; Psychology, School of Science
Background: This study explored the rewards and difficulties of raising an adolescent and investigated parents' level of interest in receiving guidance from healthcare providers on parenting and adolescent health topics. Additionally, this study investigated whether parents were interested in parenting programs in primary care and explored methods in which parents want to receive guidance. Methods: Parents of adolescents (ages 12-18) who attended an outpatient pediatric clinic with their adolescent were contacted by telephone and completed a short telephone survey. Parents were asked open-ended questions regarding the rewards and difficulties of parenting and rated how important it was to receive guidance from a healthcare provider on certain parenting and health topics. Additionally, parents reported their level of interest in a parenting program in primary care and rated how they would like to receive guidance. Results: Our final sample included 104 parents, 87% of whom were interested in a parenting program within primary care. A variety of parenting rewards and difficulties were associated with raising an adolescent. From the list of parenting topics, communication was rated very important to receive guidance on (65%), followed by conflict management (50%). Of health topics, parents were primarily interested in receiving guidance on sex (77%), mental health (75%), and alcohol and drugs (74%). Parents in the study wanted to receive guidance from a pediatrician or through written literature. Conclusions: The current study finds that parents identify several rewarding and difficult aspects associated with raising an adolescent and are open to receiving guidance on a range of parenting topics in a variety of formats through primary care settings. Incorporating such education into healthcare visits could improve parents' knowledge. Healthcare providers are encouraged to consider how best to provide parenting support during this important developmental time period.
The Natural Course of Adolescent Depression Treatment in the Primary Care Setting
(Elsevier, 2020) McCord Stafford, Allison; Garbuz, Tamila; Etter, Dillon J.; Adams, Zachary W.; Hulvershorn, Leslie A.; Downs, Stephen M.; Aalsma, Matthew C.; School of Nursing
Introduction: Little is known about how adolescents receive depression follow-up in primary care. The purpose of this study was to describe the rates of symptom assessment and depression treatment over time in a group of adolescents screening positive for moderate or severe depression in the primary care setting. Methods: Retrospective chart reviews were conducted to gather information related to symptom reassessments, antidepressant prescriptions, psychotherapy referrals, and treatment discontinuation. Descriptive statistics were calculated, and a qualitative content analysis was conducted to determine the reasons for treatment discontinuation. Results: Eighty records were reviewed (mean age = 15.3, 73% female, 59% Black). Treatment was initiated for 83% (n = 66) of patients, and 45% (n = 30) of patients discontinued treatment during the review period for a variety of reasons. Discussion: To improve adolescents' adherence to depression treatment, providers should address factors that contribute to treatment discontinuation and use tools to manage depression follow-up care.
Improving Integration of Behavioral Health Into Primary Care for Adolescents and Young Adults
(Elsevier, 2020-08) Pitts, Brian; Aalsma, Matthew C.; Brooks, Merrian; Galagali, Preti; McKinney, Robert, Jr.; McManus, Peggy; Pinto, Melissa; Radovich, Ana; Richardson, Laura; Pediatrics, School of Medicine
Problems related to mood, substance use, anxiety, body image issues, post-traumatic stress, and suicidality are common in adolescence and become even more common in young adulthood. Integrated behavioral health (IBH) in primary care has shown great promise in identifying and treating adolescents and young adults who have these problems. Treatment outcomes in IBH settings outperform those in usual primary care settings where a primary care provider may identify behavioral health problems and refer youth to colocated or outside behavioral health specialists. Despite the success of IBH care systems, limited training opportunities and inadequate financial compensation for these services jeopardize the wide scale expansion and universal adoption of IBH. To optimize patient care, providers from all disciplines in adolescent primary care settings should have dedicated professional training in IBH. This should include incorporating IBH professional competencies into each discipline's formal training program and building interprofessional, multidisciplinary IBH training settings. Likewise, payers should work with primary care systems to create and implement reimbursement models for IBH services. Efforts to expand the footprint of IBH would pay off significantly by building more worldwide BH systems with increased efficacy at identifying and treating adolescents with BH conditions.
Burnout and Mental Health Stigma among Juvenile Probation Officers: The Moderating Effect of Participatory Atmosphere
(Springer, 2019-03) Dir, Allyson L.; Saldana, Lisa; Chapman, Jason E.; Aalsma, Matthew C.; Pediatrics, School of Medicine
Despite high rates of mental health problems among juvenile justice-involved youth, mental health stigma among juvenile probation officers (JPOs) is under-studied. This cross-sectional study examined effects of job burnout and workplace participatory atmosphere on mental health stigma among JPOs across Indiana (n = 226). Participatory atmosphere moderated the relationship between JPO burnout-related cynicism and mental health stigma (interaction β = - 0.14, p = .04); burnout was related to greater mental health stigma at low levels of participatory atmosphere. Findings suggest participatory atmosphere mitigates effects of burnout on mental health stigma among JPOs. Organizational-level interventions might help to reduce mental health stigma and combat negative effects from burnout among JPOs.
4. Getting A Grip On My Depression: A Grounded Theory Explaining How Latina Adolescents Experience, Self-Manage, And Seek Treatment For Depressive Symptoms
(Journal of Adolescent Health, 2019) McCord Stafford, Allison; Aalsma, Matthew C.; Bigatti, Silvia M.; Oruche, Ukamaka M.; Burke Draucker, Claire
Latina adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than White peers. Although evidence-based treatments exist to treat adolescent depression, few treatments have been modified to meet the cultural needs of this population. In order to develop culturally sensitive strategies for preventing, identifying, and treating depressive symptoms in Latina adolescents, it is necessary to understand how they experience, self-manage, and seek treatment for their depressive symptoms over time from their own perspective. The purpose of this study was to develop a theoretical framework that explains how Latina adolescents experience, self-manage, and seek treatment for their depressive symptoms.

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