title: The role of providers in mental health services offered to American-Indian youths.
abstract: OBJECTIVE
  American-Indian adolescents have high rates of addiction and mental health problems but low rates of service use. The gap between service need and use appears to be even larger than the known gap for the general population, and few of the services are provided by specialists. This study examined receipt of treatment by American-Indian youths for addictions or mental health problems, the service provider who first identified a problem and sent a youth to treatment, and the extent to which the provider's knowledge and assessment predicted variance in service actions.
  
  
  METHODS
  A sample of 401 American-Indian youths (196 from an urban area and 205 from a reservation) aged 12 to 19 years was first interviewed in person in 2001. A total of 188 of the youths' treatment providers were then interviewed.
  
  
  RESULTS
  Structural equation modeling showed that 30 percent of the variance in addictions or mental health services provided to youths was predicted by the provider's assessment of the youth's mental health, the provider's resource knowledge, and provider type.
  
  
  CONCLUSIONS
  The results demonstrate that professional, informal, and traditional providers play a pivotal role in providing treatment services offered to American-Indian youths and that these providers were more likely to identify a youth's problems and to offer and refer services when the provider knew more about community resources for the youth and about the youth's personal and environmental problems.
authors.affiliation: George Warren Brown School of Social Work, Washington University, St. Louis, MO 63130, USA. arstiff@wustl.edu
authors.forename: Arlene Rubin
authors.initials: AR
authors.lastname: Stiffman
authors.forename: Stacey
authors.initials: S
authors.lastname: Freedenthal
authors.forename: Peter
authors.initials: P
authors.lastname: Dore
authors.forename: Emily
authors.initials: E
authors.lastname: Ostmann
authors.forename: Victoria
authors.initials: V
authors.lastname: Osborne
authors.forename: Hiie
authors.initials: H
authors.lastname: Silmere
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006282:Health Personnel; D006801:Humans; D007198:Indians, North American; D007407:Interviews as Topic; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D024382:Professional Role; D019966:Substance-Related Disorders