Children and Youth with Special Health Needs (CYSHN)
Chemical Use and Mental Health Disparities in Youth with Chronic Illness and Disabilities
Since 1992, the Minnesota Student Survey (1) has been administered every three years to sixth, ninth and twelfth grade students. Beginning in 1998, the survey has included a question that allows participants to identify themselves as having “a physical, mental or other health condition that has lasted at least twelve months”. The addition of this question provides a means to identify students with special health needs and compare what they are saying with their peers’ responses. The most recent survey was completed in the spring of 2004 and with the analysis of those results; there are now three sets of data that allow for the observation of trends over the past six years.
In this most recent survey, 14.3% of students responded “yes” to the question “Do you have a mental or physical condition or other health problem that has lasted at least twelve months”. Comparing the responses of this group of students with those students who responded “no” to this same question allows for the identification of differences as well as similarities that are of interest to those who work with children with special health needs.
What Students Told Us
Youth who identified themselves as having a special health need were more than twice as likely as their peers to report feeling sad, discouraged or hopeless all or most of the last thirty days. This same group was also twice as likely to have run away from home in the last twelve months. Other trends that have persisted over the last three administrations of the survey include students who identify themselves as having a special health need have much higher rates of suicidal thoughts and attempts, higher rates of physical abuse within their family, and higher rates of sexual abuse both in and outside of their family than do their peers.
Another area of concern that has emerged in looking at this data relates to the use of alcohol, tobacco and other drugs. Youth who identified themselves as having a special health need:
- Were slightly more likely to use tobacco and marijuana
- Were more likely to use illegal drugs (including psychedelics, ecstasy, crack or coke, meth, amphetamines, barbiturates, and heroin)
- Were more likely to use inhalants
- Were more likely to use other people’s prescription medications
- Began using alcohol at an earlier age
What is most striking in the analysis of the results is in their reasons for using. While the number one reason for using with both groups was “to have fun at parties”, many of the reasons that followed differed significantly. The group who identified themselves as having special health needs was more likely than their peer group to use to get high or smashed; to escape; because they are sad, lonely or angry; or because their parents do.
Reasons for using drugs or alcohol: (check all that apply)
|9th grade||12th grade|
|Has a mental or physical condition or health problem that has lasted at least 12 months|
|To have fun at parties|
|To get high or smashed||
|To escape from school / family / personal problems|
|Because I'm sad, lonely, or angry|
|Because my parents do|
Why This is Important
This information may not surprise professionals who routinely see these students, but the implications of these differences are significant. It would be in the public’s best interest, as well as for the well being of the individual students, to intervene before youth engage in substance use and abuse. Results from the survey indicate that pediatricians have opportunity to intervene. Youth who identify themselves as having a special health need report more recent and regular contact with their health care providers than do their peers. Offering anticipatory guidance on the use of substances is certainly best practice when seeing all youth for any health appointment, but equipped with the knowledge that the reasons for use appear to differ significantly could allow for a much more targeted and effective approach toward preventing this risk behavior in youth with special health needs.
Armed with this knowledge, the following are potential intervention ideas that could be implemented during a health care provider’s encounter with individual youth who have special health needs:
- Assure time alone with youth, without parent or guardian present, to address these sensitive issues
- Make every effort build a relationship that promotes a safe environment for youth to honestly discuss concerns
- Routinely screen for mental health / social emotional issues specifically to identify youth who are experiencing sadness, loneliness and anger and appropriately refer for treatment
- Ask about desire to “escape” and offer healthy alternatives for dealing with perceived hardships
- Ask about parental use of tobacco, alcohol and other drugs
- Offer healthy alternatives for “getting high” (i.e. realistic opportunities for physical activity)
- Ask about what they do for fun and offer healthy alternatives
On a positive note, efforts aimed at inclusion are apparently paying off. Youth who identify themselves as having a special health need are reporting rates very similar to their peers for involvement in a variety of activities. These activities include doing homework, music activities, organizations outside school, playing sports on school team, other physical activities, attending religious activities, reading for pleasure, watching TV or videos, community service, chores at home, working for pay, and just hanging out.
Encouraging schools to continue participation in the Minnesota Student Survey will help assure that this data continues to be available to guide the implementation of evidenced based interventions on behalf of all youth.