a CDC Prevention Research Center at the Johns H opkins Bloomberg School of Public H ealth
HEALTHY MINDS AT WORK
Improving mental health and lifecourse outcomes in
Opportunity Youth
Amanda Latimore, PhD
Objectives
• Section I: Local and national Opportunity Youth
– Characteristics
– Immediate and long-term effects
– Why context matters for urban youth
– Barriers to success
• Section II: Healthy Minds At Work
– Intervention designed for Opportunity Youth
focusing on mental health
– Results of HMAW evaluation
• Mental health
• Lifecourse impact: employment, education and incarceration
2
Opportunity Youth: Who
• One out of six (6.7M) youth ages 16-24 are neither
working nor in school in the US
• Higher % OY among poor and minorities
– 60% from poor or working class families
• Male and female OYs
– Females more likely to have family responsibilities
– Males more likely to be incarcerated
• US OY are heterogeneous
Belfield, C., Levin, H. and Rosen, R. (2012), The Economic Value of Opportunity Youth in association with Civic. Enterprises for the W.K. Kellogg Foundation
White House Council for Community Solutions (2012), Final Report: Community Solutions for Opportunity Youth
3
Opportunity Youth Status by Race and Age
Belfield, C., Levin, H. and Rosen, R. (2012), The Economic Value of Opportunity Youth in
association with Civic. Enterprises for the W.K. Kellogg Foundation
4
Opportunity Youth: What & When
• Immediate and long-term consequences
– Cost to individual
• HS graduation rate 18% pts lower for OY
– 1% of OY have AA by age 28 (vs 36%)
• Lifetime earnings 2-3% less per OY year
• $375K vs $712K for HS graduate
– Cost to society
• Tax payer burden: $13,900/yr
• Immediate social burden: $37,450/yr
Highest level Income,
of education age>25
< HS
$19,500
HS
$27,600
College
$50,000
Grad school
$65,000
Belfield, C., Levin, H. and Rosen, R. (2012), The Economic Value of Opportunity Youth in association with Civic. Enterprises for the W.K. Kellogg Foundation
White House Council for Community Solutions (2012), Final Report: Community Solutions for Opportunity Youth
US Census Bureau, ACS, 2007-2011
5
The $MILLION DOLAR$ Youth
500000
$461,016
450000
400000
350000
$294,885
300000
250000
200000
150000
$148,790
$109,450
100000
50000
0
16-24
tax payer burden
25+
social burden
Belfield, C., Levin, H. and Rosen, R. (2012), The Economic Value of Opportunity Youth in association with Civic. Enterprises for the W.K. Kellogg Foundation
6
7
8
Baltimore
City
9
10
11
12
13
14
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Opportunity Youth: Where
• 50 largest cities account for
– 1 in 9 youth entering HS
– 1 in 4 not graduating on
time
• Public schools graduate only
about 70% of their students,
with this figure dropping to
below 50% in many urban
areas
16
Opportunity Youth: Why & How
Disadvantaged
neighborhoods
racism, poverty, violence,
substance abuse, lack of
resources and opportunities,
limited services
• Urban youth at higher risk for mental illness
• 35% of urban youth exposed to violence develop
PTSD vs. 4-6% of general adolescent population
• 25% of adolescents and young adults, ages 16-24,
will experience a depressive episode by age 24
• Barriers to academic and career success
Alicea, et al., 2012; Morris, 2009; Kilpatric et al., 2003; Kessler & Walters, 1998;
Kessler et al., 2005
17
N= 15,931
• Female: 51%
• Black: 79%
• Education
• 39% < HS
• 49% HS
• 12% some college,
no degree
• Custodial parent: 23%
• Referred to juvenile
justice services: 28%
• Incarcerated:
US Census CPS, KIDS COUNT, BNIA
18
Why Focus on Mental Health?
• In 2004–2005, 45% of students with an emotional
disorder dropped out of high school
• Untreated mental illness accounts for high rates of
absenteeism and tardiness.
– Referral to a school-based mental health center or to
counseling reduces absenteeism(50%) & tardiness(25%)
• GAO Report on “Disconnected Youth” noted mental
health as significant challenge facing employment
and training program participants
U.S. Department of Education, Report to Congress, 2009; Gall, Pagano, Desmond, Perrin, & Murphy, 2000
19
Project Background - HMAW
• U.S. Department of Labor Funding for two
Youth Opportunities (YO) programs in Baltimore
– Serves youth 16-22 not in school or the workplace
– Over 95% of participants are African American
• Baltimore City Health Department and Mayor’s
Office of Employment Development interested
in partnering with researchers to address YO
members’ health needs
• Participatory process identified mental health
as focus for partnership
20
Healthy Minds at Work
• Collaboration led to an intervention for out-ofschool youth participating in YO! (Youth
Opportunity) with the goal of improving mental
health, education and employment outcomes
• Four components delivered in a job-training context
– Training for YO! program staff and peer leaders
– A program of education activities for YO! members (clinician
sessions, group therapy, workshops, SOS)
– Streamlined screening for all newly enrolling YO! members
– Comprehensive clinical services for YO! members
21
Peer-led SOS
• For YO participants with moderate-to-severe
depression
• Adapted SPARCS curriculum to serve as a
prevention program
– SPARCS (Structured Thx for Adol Responding to Chronic
Stress) – treatment program
– Group-based
• Teach youth how to RAP (Relax, Aware, Personal
Rating)
22
Healthy Minds at Work
• Quasi-experimental design
– Intervention site: Eastside YO (N = 512) received on-site
clinician services, psychoeducational workshops, SOS
– Control site: Westside YO (N = 270) received limited onsite clinician services and life skills training
• Baseline, 6- and 12-month assessments of
participant mental health, service receipt,
employment, incarceration and educational
attainment information
• All analyses propensity-score matched
23
Healthy Minds at Work
Baseline demographics (N = 782)
Variable
Mean Age (SD) [Range]
Female (%)
Black (%)
Hispanic (%)
No GED or high school diploma (%)
Currently employed (full or part-time, %)
Involved in a fight, last 12 mos (%)
Carried a weapon, lifetime (%)
Witnessed a homicide, lifetime (%)
Friend died (%)
Binge drinking, last 30 days (%)
Marijuana, last 30 days (%)
Conviction prior to enrollment, 18+ (%)
Provides for 1+ child in the household (%)
18.8 (1.7) [16-23]
50.6
93.7
0.8
84.5
11.8
86.4
48.6
20.8
50.1
30.3
44.2
29.6
33.1
24
Belfield, C., Levin, H. and Rosen, R. (2012), The Economic Value of Opportunity Youth in association with Civic. Enterprises for the W.K. Kellogg
Foundation
25
Mental Health and Service Receipt at Baseline
Moderate to high depressive symptoms (CESD > 16, %)
Symptoms of post traumatic stress disorder (PCL-C > 30, %)
Symptoms of high anxiety (BAI > 16, %)
At least one of the above
Received mental health services
Received MH services in the last 12 mos for problems with behaviors,
feelings, drugs, or alcohol (N = 234)
Mean # mental health services among those with >0 services
Most common services utilized among those with >0 services
Probation or juvenile corrections officer
Detention center, prison or jail
Community mental health center
Emergency room
36.5
41.9
11.8
51.3
19.6
30.3
2.4 (1.8)
24.8
24.3
16.2
13.7
26
Healthy Minds at Work: Engagement
• Mental health program engagement (N = 512)
– 88.1% with any service (clinician, workshop, SOS)
• No gender differences
Workshop Type
– Median number of services: 3 [range: 1, 59]
27
Healthy Minds at Work: Engagement
• Total days engaged: 86.6 (SD = 121.4)
• Gap between services: Mean = 23.1 days (SD = 56.0)
28
Healthy Minds at Work: Engagement
• Timing of service engagement: 70% within
the first 6 months
?
Baseline
?
6 months
?
12 months
29
Mental Health Outcomes
30
31
Intervention Effects – Coping Skills
Overall Coping, 12 months
Low baseline depression
High baseline depression
Change
95% CI
p-value
Change
95% CI
p-value
Men
0.17
-0.05, 0.39
.14
0.82
0.51, 1.14
.00
Women
0.19
0.01, 0.37
.04
-0.15
-0.36, 0.06
.15
Depressive Symptoms, 12 months
Low baseline depression
Change
95% CI
Men
1.31
-1.54, 4.17
.37
Women
.0.36
-2.98, 3.70
.83
High baseline depression
p-value Change
95% CI
p-value
-5.64
-10.30, -0.96
.02
10.08
6.21, 13.96
.00
Children’s coping checklist range: 1, 4
Mean CESD at baseline: 14.8 (SD 9.9)
5
Men, Low depressive symptoms at baseline
3.36
Women, Low depressive symptoms at baseline
2.99
3.46
5
-15 -10
-5
0
1.13
Intervention Effect: 2.43, p = .127
Comparison
Intervention
Men, High depressive symptoms at baseline
Intervention Effect: -8.81, p = .000
Intervention Effect: -.152, p = .931
Comparison
Intervention
Women, High depressive symptoms at baseline
Intervention Effect: 8.90, p = .000
0
1.99
-2.75
-5
-15 -10
Predicted change in CESD score at 12 months compared to baseline
Intervention Effects – Depression
-7.26
-12.4
Comparison
Intervention
Comparison
Intervention
33
Dose Effect - Depression
34
Lifecourse Outcomes
• Employment
– Self-reported
– UI Wage data (Jacob France)
• Education
– Math TABE
– Reading TABE
• Incarceration
35
Intervention Effects – Men
RR of Employment among those unemployed at baseline
6 months
100
16 - 17
IRR = 4.09, p = .046
18 - 19
IRR = 2.11, p = .039
12 months
20 - 23
IRR = 1.09, p = .883
16 - 17
18 - 19
IRR = 1.06, p = .918
IRR = .510, p = .026
20 - 23
IRR = .245, p = .000
60
40
45.2
27.2
23.7
23.3
20
18.3
22.2
16.1
14.6
19.6
17.7
3.4
0
Predicted Employment, %
80
96.7
Comp Intervention
Comp Intervention
Comp Intervention
Comp
Intervention
Comp
Intervention
Comp
Intervention
36
Employment Outcomes
6 months
N
MEN
Relative risk of selfreported employment
Ages 16-17
Intervention
Effect
12 months
CI
p
N
Intervention
Effect
CI
p
201
2.02
1.02, 3.99
.043
181
.443
.261, .751
.003
65
4.09
1.02, 16.3
.046
54
1.06
.346, 3.25
.918
Ages 18-19
81
2.11
1.04, 4.31
.039
72
.510
.282, .923
.026
Ages 20-23
55
1.09
.332, 3.60
.883
55
.245
.127, .471
.000
346
.882
.548, 1.42
.604
346
.770
.539, 1.10
.150
Relative risk of UI
Wage Employment
37
Baseline only
12.6
81.7
9.8
86.2
14.4 10.1
27.4
13.7 10.6
(N = 208)
Baseline & 6mos
15.4
13.2
18.3
6.3 8.6
(N = 130)
Baseline & 12
16.3
78.1
24.7
14.4
37.1
17.7
13.5
(N = 97)
All 3 time points
19.1
75.9
24.8
18.8
35.3
17.6
17.4
(N = 347)
GED or diploma
Had a normal week
Overnight patient in hospital
Received other school counseling services
Family w/ drug/alcohol problem
Family robbed
Family member needs help with behavior, emotions or feelings
38
Intervention Effects – Education
Math
Reading
Female
Avg change: 1.27, p = .000
Avg change: .758, p = .060
1.5
Male
Male
Female
Avg change: 1.20, p = .004
Avg change: .291, p = .538
1.3
1.2
1.0
1
.5
0.7
0.3
0
0.2
-0.2
-.5
Predicted Change in TABE Score
1.0
Comparison
Intervention
Comparison
Intervention
Comparison
Intervention
Comparison
Intervention
39
Intervention Effects – RR of Incarceration among 18+
6 months
12 months
.411
Female
.377, 2.21
.839
.274
Male
.062, 1.21
40
40
Male
.088
.345
Female
.173, .689
.004
.566
.208, 1.54
.264
30
16.0
13.0
20
Predicted Incarceration, %
20
Predicted Incarceration, %
30
34.0
13.0
10
10
4.3
5.6
3.1
0
0
1.2
Comparison
Intervention
Comparison
Intervention
Comparison
Intervention
Comparison
Intervention
• 23% served jail or prison time within 2 years of enrollment
40
Summary of Results
Improvements in
• Mental Health
– Depression: men at 12 months, both intervention and control group for
women
– Coping: high-depression men and low-depression women
• Employment
– Self-reported: younger men at 6 months
– UI Wage: no effect
• Education
– Math: men and women
– Reading: men
• Incarceration
– Women at 6 mos
– Men at 12 mos
41
Conclusions
• Urban youth have significant mental health needs
• Successful engagement of high-risk & disconnected youth
in mental health services
• Mental health intervention associated with
– Higher rates of employment
– Improved coping skills and reduced depressive symptoms
– Reduction in incarceration
42
HMAW Extensions
• Tamar Mendelson – School-based study of SOS/RAP curriculum
• While addressing mental health is valuable, youth have very real needs
• The top obstacles to reconnecting to school
–
–
–
–
–
63% can’t affort it
48% need to make money to take care of their families
40% need transportation
40% struggle to balance work and school
32% say no one showed them how to apply to college or helped them
figure out how to pay for it
• 79% want to reconnect through successful peers to whom they can
relate
• 78% want “Learn and Earn” job opportunities
White House Council for Community Solutions (2012), Final Report: Community Solutions for Opportunity Youth
US Census Bureau, ACS, 2007-2011
43
How Can We Reconnect OY?
www.BCOYC.org
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