Heterogeneity in Youth Symptom Trajectories Following Psychiatric Crisis: Predictors and Placement Outcome.

The authors examined heterogeneity in symptom trajectories among youths following psychiatric crises as well as the psychosocial correlates and placement outcomes associated with identified trajectories. Using semiparametric mixture modeling with 156 youths approved for psychiatric hospitalization, the authors identified 5 trajectories based on symptoms over the 16 months following crisis: high improved, high unimproved, borderline improved, borderline unimproved, and subclinical. Membership in unimproved symptom groups was associated with less suicidality, younger age, more youth hopelessness, and more caregiver empowerment. Improved symptom group membership predicted long-term decreases in days in out-of-home placements. More important, and in contrast with general impressions from the existing literature, findings suggest that a substantive proportion of youths with serious emotional disturbance sustain high levels of symptomatology following intensive mental health services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family preservation using multisystemic therapy: An effective alternative to incarcerating serious juvenile offenders.

Multisystemic therapy (MST) delivered through a community mental health center was compared with usual services delivered by a Department of Youth Services in the treatment of 84 serious juvenile offenders and their multiproblem families. Offenders were assigned randomly to treatment conditions. Pretreatment and posttreatment assessment batteries evaluating family relations, peer relations, symptomatology, social competence, and self-reported delinquency were completed by the youth and a parent, and archival records were searched at 59 wks postreferral to obtain data on rearrest and incarceration. In comparison with youths who received usual services, youths who received MST had fewer arrests and self-reported offenses and spent an average of 10 fewer weeks incarcerated. In addition, families in the MST condition reported increased family cohesion and decreased youth aggression in peer relations. The relative effectiveness of MST was neither moderated by demographic characteristics nor mediated by psychosocial variables. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multi-objective multi-sectoral economy–energy–environment model: Application to Portugal

Portugal is faced with important challenges concerning the definition of policies to achieve energy and environmental targets, taking also into account the economic and social issues. A multi-sectoral economy-energy-environment model has been developed to perform a prospective analysis of the changes in the economic structure and the energy system, as well as to assess the corresponding environmental impacts, providing decision support in policy making. This model is a multi-objective linear programming model that allows for the explicit consideration of distinct axes of evaluation, generally conflicting and non-commensurate, of the merit of distinct policies. The policy recommendations obtained are subject to the inherent uncertainty associated with the model coefficients and, therefore, they may not be robust in face of changes of the input data. The specification of less energy or carbon-intensive technologies is done by considering pollutant/energy coefficients defined as intervals. This analysis is crucial for understanding the role of technology in carbon mitigation efforts and other energy system planning settings, allowing to explore the effects of distinct policies on the total system costs, the fuel and technology mix, and the levels of greenhouse gases and other emissions.     

A multi-criteria decision approach to sorting actions for promoting energy efficiency

This paper proposes a multi-criteria decision approach for sorting energy-efficiency initiatives, promoted by electric utilities, with or without public funds authorized by a regulator, or promoted by an independent energy agency, overcoming the limitations and drawbacks of cost–benefit analysis. The proposed approach is based on the ELECTRE-TRI multi-criteria method and allows the consideration of different kinds of impacts, although avoiding difficult measurements and unit conversions. The decision is based on all the significant effects of the initiative, both positive and negative, including ancillary effects often forgotten in cost–benefit analysis. The ELECTRE-TRI, as most multi-criteria methods, provides to the decision maker the ability of controlling the relevance each impact can have on the final decision in a transparent way. The decision support process encompasses a robustness analysis, which, together with a good documentation of the parameters supplied into the model, should support sound decisions. The models were tested with a set of real-world initiatives and compared with possible decisions based on cost–benefit analysis.     

Contributions of sibling relations to the adaptation of youths with insulin-dependent diabetes mellitus.

Associations among sibling relations and the psychosocial and illness-specific adaptation of youths (N?=?66) with insulin-dependent diabetes mellitus (IDDM) were examined. The findings suggest that sibling relations, especially sibling conflict, contribute an independent source of variance above and beyond that contributed by demographic characteristics, sibling constellation variables, and important dimensions of family relations in predicting the youths' adaptation. High family-life stress and high sibling status/power contributed unique variance in predicting internalizing behaviors, and male gender and sibling conflict contributed independently to externalizing problems. Sibling conflict also contributed unique variance to the youths' general self-esteem, along with social class and family cohesion, and to their adjustment to IDDM. Data suggest that parent–child dyads and sibling dyads represent interrelated and independent subsystems within the family, and that both subsystems may influence the psychosocial functioning of youths with IDDM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of university mental health needs priorities identified by professionals and students.

A random and representative sample of 457 undergraduate and graduate students completed the Needs Assessment Questionnaire that required each respondent to rate on a 5-point scale the seriousness of 24 mental health problems among university students and their families. A similar questionnaire was completed by 30 university-employed mental health professionals. A comparison of the ratings given to specific mental health problems by student and professional groups revealed extensive between-groups differences. The students rated problems of substance abuse as most serious, whereas the professionals rated problems of an academic and neurotic nature as most serious. The results have important implications for the validity and utility of needs assessment strategies. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decreasing Effect Sizes for Effectiveness Studies- Implications for the Transport of Evidence-Based Treatments: Comment on Curtis, Ronan, and Borduin (2004).

The most important finding from the N. M. Curtis, K. R. Ronan, and C. M. Borduin (2004) meta-analysis for the broader field is likely the difference in effect sizes between multisys- multisystemic therapy efficacy versus effectiveness studies. This difference has important implications for research on the transport of evidence-based treatments to community practice settings. For example, factors rarely considered in efficacy research (e.g., funding structures, organizational climate, program maturity, site characteristics) are emerging as important determinants of treatment fidelity and, in turn, clinical outcomes for practice in real-world settings. Current research is clearly demonstrating that evidence-based practices can be successfully transported, but much remains to be learned regarding the optimal parameters of such transport. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of an audiotape review system for supporting adherence to an evidence-based treatment.

In bridging the science-to-service gap, effective yet practical strategies are needed for supporting practitioner implementation of evidence-based treatments. The development and preliminary evaluation of an adherence monitoring system to support clinician fidelity to an evidence-based treatment for substance-abusing adolescents was tested for community-based practitioners. Session tapes were monitored for adherence to a family-based approach to contingency management for 27 practitioners during baseline, postworkshop, and follow-up periods. Approximately half of the practitioners were randomized to receive intensive quality assurance following a family-based contingency management workshop as part of a larger study. Findings supported the clinical feasibility of the developed system as well as the face and content validity, reliability, and concurrent validity. Future directions are discussed in light of these results, including instructions for the use of the developed system to efficiently train clinicians to adequate fidelity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)