Mental and reproductive health in multisystem youth: An in-depth qualitative approach

Background: Multisystem youth involved in both the child welfare and juvenile justice systems report elevated rates of risky sexual behaviors, associated health problems as well as having a disproportionally higher risk for concurrent mental health disorders. Objective: The current study aimed to provide in-depth nuanced insights about mental and reproductive needs and challenges of multisystem youth using a multi-informant approach (youth, parole/probation officers). Participants and setting: Qualitative in-depth interviews were conducted with multisystem youth (N = 15; 14-17-years-old; 40% females) and parole/probation officers (N = 20; 35-67-years-old; 33% females) working with foster care and juvenile justice systems. Methods: Informed by Socio-Ecological Theory, analyses were conducted using Thematic Network Analysis (TNA) and qualitative software Atlas.ti.7. Results: Youth and parole/probation officers identified key challenges related to mental health (e.g., criminalization of behaviors, unstandardized screening procedures), reproductive health (e.g., abnormalization of sexual behaviors, lack of parenting and comprehensive reproductive services), and shared challenges across systems (e.g., lack of data sharing across systems, overuse of "crisis" procedures, lack of trauma-informed providers and services). Conclusions: Multisystem youth have significant mental and reproductive health needs that are not adequately met mostly due to system and institutional challenges, differences in protocols, and discontinuance of services and treatment across systems among other problems. Mental and reproductive health disparities are key factors in stigmatization, criminalization and further victimization of youth across systems. Multidisciplinary and multisectoral partnerships are key to advance service, protocols and procedural gaps that address the mental and reproductive health needs of multisystem youth.