title: Patterns of service use, individual and contextual risk factors, and resilience among adolescents using multiple psychosocial services.
abstract: BACKGROUND
  Very little research has examined the relationship between resilience, risk, and the service use patterns of adolescents with complex needs who use multiple formal and mandated services such as child welfare, mental health, juvenile justice, and special educational supports. This article reports on a study of 497 adolescents in Atlantic Canada who were known to have used at least 2 of these services in the last 6 months. It was hypothesized that greater service use and satisfaction with services would predict both resilience, and better functional outcomes such as prosocial behavior, school engagement and participation in community.
  
  
  METHODS
  Youth who were known to be multiple service users and who were between the ages of 13 and 21 participated in the study. Participants completed a self-report questionnaire administered individually. Path analysis was used to determine the relationship between risk, service use, resilience, and functional outcomes. MANOVA was then used to determine patterns of service use and service use satisfaction among participants.
  
  
  RESULTS
  Findings show that there was no significant relationship between service use history and resilience or any of the three functional outcomes. Service use satisfaction, a measure of an adolescent's perception of the quality of the services received, did however show a strong positive relationship with resilience. Resilience mediates the impact of risk factors on outcomes and is affected positively by the quality, but not the quantity, of the psychosocial services provided to adolescents with complex needs.
  
  
  CONCLUSIONS
  Results show that resilience is related to service satisfaction but not the quantity of services used by youth. Coordinated services may not increase resilience or be more effective unless the quality of individual services is experienced by an adolescent receiving intervention as personally empowering and sensitive to his or her needs.
authors.affiliation: Resilience Research Centre, Dalhousie University, Halifax, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Ungar
authors.forename: Linda
authors.initials: L
authors.lastname: Liebenberg
authors.forename: Peter
authors.initials: P
authors.lastname: Dudding
authors.forename: Mary
authors.initials: M
authors.lastname: Armstrong
authors.forename: Fons J R
authors.initials: FJ
authors.lastname: van de Vijver
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D002648:Child; D002669:Child Welfare / Q000523:psychology*; D003430:Cross-Sectional Studies; D004519:Education, Special; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult