15. Henggeler, S. W. (1994). A consensus: Conclusions of the APA Task Force report on innovative models of mental health services for children, adolescents, and their families. Journal of Clinical Child Psychology, 23(Suppl), 3-6.
23. Sondheimer, D., Schoenwald, S. K., & Rowland, M. D. (1994). Alternatives to the hospitalization of youth with a serious emotional disturbance. Journal of Clinical Child Psychology, 23(Suppl), 7-12.
24. Borduin, C. M., Henggeler, S. W., & Manley, C. (1995). Conduct and oppositional disorders. In V. B. Van Hasselt & M. Hersen (Eds.), Handbook of adolescent psychopathology: A guide to diagnosis and treatment. (pp. 349-383). New York: Lexington Books.
29. Henggeler, S. W., Schoenwald, S. K., & Munger, R. L. (1996). Families and therapists achieve clinical outcomes, systems of care mediate the process. Journal of Child and Family Studies, 5,177-183.
30. Henggeler, S. W., & Santos, A. B. (Eds.). (1997). Innovative approaches for "difficult- to-treat" populations. Washington, D.C.: American Psychiatric Press. (Book)
31. Henggeler, S. W., & Santos, A. B. (1997). Introduction, overview, and commonalities of innovative approaches. In S. W. Henggeler & A. B. Santos (Eds.), Innovative approaches for "difficult-to-treat" populations, (pp. xxiii-xxxiii). Washington, D.C.: American Psychiatric Press.
32. Henggeler, S. W., Schoenwald, S. K., & Pickrel, S. G. (1995). Multisystemic therapy: Bridging the gap between university- and community-based treatment. Journal of Consulting and Clinical Psychology, 63(5), 709-717.
33. Munger, R. L. (1997). Ecological trajectories in child mental health. In S. W. Henggeler & A. B. Santos (Eds.), Innovative approaches for "difficult-to-treat" populations, (pp. 3-25) Washington, D.C.: American Psychiatric Press.
35. Rowland, M. D., Burns, B. J., Schafft, G., Randolph, F. L., & McAninch, C. B. (1997). Innovative services for the elderly population. In S. W. Henggeler & A. B. Santos (Eds.), Innovative approaches for "difficult-to-treat" populations, (pp. 289-310). Washington, D.C.: American Psychiatric Press.
36. Santos, A. B., Henggeler, S. W., Burns, B. J., Arana, G. W., & Meisler, N. (1995). Research on field-based services: Models for reform in the delivery of mental health care to populations with complex clinical problems. The American Journal of Psychiatry, 152(8), 1111-1123.
43. Schoenwald, S. K., & Henggeler, S. W. (1997). Combining effective treatment approaches with family preservation models of service delivery: A challenge for mental health. In R. J. Illback, C. T. Cobb & H. M. Joseph, Jr. (Eds.), Integrated services for children and families: Opportunities for psychological practice (pp. 121-136). Washington, DC: American Psychological Association.
52. Henggeler, S. W., Rowland, M. D., Pickrel, S. G., Miller, S. L., Cunningham, P. B., Santos, A. B., Schoenwald, S. K., Randall, J. & Edwards, J. E. (1997). Investigating family-based alternatives to institution-based mental health services for youth: Lessons learned from the pilot study of a randomized field trial. Journal of Clinical Child Psychology, 26, 226-233.
53. Cunningham, P.B., Henggeler, S.W., & Pickrel, S.G. (1996). The cross-ethnic equivalence of measures commonly used in mental health services research with children. Journal of Emotional and Behavioral Disorders, 4, 231-239.
61. Schoenwald, S.K., & Henggeler, S.W. (1999). Treatment of Oppositional defiant disorder and conduct disorder in home and community settings. In H.C. Quay & A. E. Hogan (Eds.), Handbook of disruptive behavior disorders (pp 475-494). New York: Plenum Press.
63. Randall, J., & Henggeler, S.W. (1999). Multisystemic therapy: Changing the social ecologies of youths presenting serious clinical problems and their families. In S. Russ and T.H. Ollendick, Handbook of Psychotherapies with Children and Families, 21, 405-418. New York: Plenum Press.
64. Schoenwald, S.K., Ward, D.M., Henggeler, S.W., & Rowland, M.D. (2000). MST vs. hospitalization for crisis stabilization of youth: Placement outcomes 4 months post-referral. Mental Health Services Research, 2(1), 3-12.
68. Brown, T. L., Borduin, C. M., & Henggeler, S. W. (2001). Treating juvenile offenders in community settings. In J. B. Ashford, B. D. Sales, & W. Reid (Eds.), Treating adult and juvenile offenders with special needs (pp.445-464). Washington, DC: American Psychological Association.
79. Swenson, C.C., & Spratt, E.G. (1999). Identification and treatment of child physical abuse through medical and mental health collaborations. Children’s Health Care, 28(2), 123-139.
88. Henggeler, S.W.,Rowland, M.D.,Randall, J., Ward, D.M.,Pickrel, S.G.,Cunningham, P.B.,Miller, S.L., Edwards, Zealburg J.J.,Hand, L.D., & Santos, A.B. (1999). Home based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of the American Academy of Child & Adolescent Psychiatry, 38,1331-1339.
98. U.S. Surgeon General's Report on Mental Health (1999). Sections on multisystemic therapy outcomes.
217. Jones, R. T., Ribbe, D. P., Cunningham, P. B., Weddle, J. D., Langley, A. K. (2002). Psychological impact of fire disaster on children and their parents. Journal of Behavior Modification, 26(2), 163-186.
218. Jones, R. T., Randall, J. (2002). How children cope in a fire emergency. Journal of Fire Engineering, February 2002, 85-96.
219. Randall, J., Halliday-Boykins, C. A., Cunningham, P. B., Henggeler, S. W. (2001). Integrating evidence-based substance abuse treatment into juvenile drug courts: Implications for outcomes. National Drug Court Institute Review, Vol. III, 2, 89-115.
227. Clingempeel, W.G., & Henggeler, S.W. (2003). Aggressive juvenile offenders transitioning into emerging adulthood: Factors discriminating persistors and disistors. American Journal of Orthopsychiatry, Vol. 73, No. 3, 310-323.
228. Cunningham, P.B., Foster, S.L., & Henggeler, S.W. (2002). The elusive concept of cultural competence. Journal of Children's Services: Social Policy, Research, and Practice, 5(3), 231-243.
231. Henggeler, S.W., Rowland, M.D., Halliday-Boykins, C., Sheidow, A, J., Ward, D.M., Randall, J., Pickrel, S.G., Cunningham, P.B., Edwards, J. (2003) One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis. Journal of the American Academy of Child & Adolescent Psychiatry, 42, 543-551.
247. Huey, S.J., Jr., Henggeler, S.W., Rowland, M.D., Halliday-Boykins, C.A., Cunningham, P.C., Pickrel, S.G., & Edwards, J. (2004). Multisystemic therapy effects on attempted suicide by youth presenting psychiatric emergencies. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 183-190.
251. Halliday-Boykins, C.A., Henggeler, S.W., & Rowland, M.D., & DeLucia, C. (2004). Heterogeneity in youth symptom trajectories following psychiatric crisis: Predictors and placement outcomes. Journal of Consulting and Clinical Psychology, 72, 993-1003.
252. Rowland, M.D., Halliday-Boykins, C.A., Schoenwald, S.K. (2004). Multisystemic therapy with youth exhibiting significant psychiatric impairment. In Epstein, M.H., Kutash, K., & Duchnowski, A. J. (Eds.), Outcomes for Children and Youth with Emotional and Behavioral Disorders and Their Families: Programs and Evaluation Best Practices, (pp. 401-419). Pro-Ed, Inc., Austin, Texas.
253. Sheidow, A.J., Bradford, W.D., Henggeler, S.W., Rowland, M.D., Halliday-Boykins, C., Schoenwald, S.K., Ward, D.M. (May 2004). Treatment costs for youths receiving multisystemic therapy or hospitalization after a psychiatric crisis. Psychiatric Services, 55, 548-554.
*** Henggeler, S.W., Schoenwald, S.K., Rowland, M.D., and Cunningham, P.B. (2002). Serious emotional disturbance in children and adolescents: Multisystemic therapy . New York : Guilford Press. http://www.guilford.com
260. Sheidow, A.J., Henggeler, S.W. (2005). Community-based treatments. In Heilbrun, K., Sevin Goldstein, N.E., Redding , R. (Eds.), Juvenile Delinquency (pp. 257-281). Oxford University Press.
262. Rowland, M.D., Halliday-Boykins, C.A., Henggeler, S.W., Cunningham, P.B., Lee, T.G., Kruesi, M.J.P., & Shapiro, S.B. (2005). A randomized trial of multisystemic therapy with Hawaii 's Felix Class youths . Journal of Emotional and Behavioral Disorders, 13(1).13-23.
265. Cunningham, P. B., & Foster, S. L. (2005). Operationalizing cultural competence: One programmatic effort. Child and Family Policy and Practice Review, 1(1), 12-15.
274. Huey, S.J., Henggeler, S.W., Rowland, M.D., Halliday-Boykins , C.A. , Cunningham, P.B., & Pickrel, S.G. (2005). Predictors of treatment response for suicidal youth referred for emergency psychiatric hospitalization. Journal of Clinical Child and Adolescent Psychology , 34(3), 582-589.
303. Stambaugh, L.F., Mustillo, S.A., Burns, B.J., Stephens, R.L., Baxter, B., Edwards, D., DeKraai, M. (2007). Outcomes from wraparound and multisystemic therapy in a center for mental health services system-of-care demonstration site. Journal of Emotional and Behavioral Disorders, 15(3), 143-155.
328. Sheidow, A.J., Strachan, M.K., Minden, J.A., Henry, D.B., Tolan, P.H., & Gorman-Smith, D. (2008). The relation of antisocial behavior patterns and changes in internalizing symptoms for a sample of inner-city youth: Comorbidity within a developmental framework. Journal of Youth and Adolescence, 37, 821-829.
340. Capella, E., Frazier, S.L., Atkins, M.S., Schoenwald, S.K., & Glisson, C. (2008). An ecological model of school-based mental health services: Enhancing schools' capacity to support children in poverty. Administration and Policy in Mental Health and Mental Health Services Research, 76(4), 556-567.
411. Sheidow, A. J., McCart, M. R., Zajac, K., Davis, M. (2012). Prevalence and impact of substance use among emerging adults with serious mental health conditions. Psychiatric Rehabilitation Journal, 35, (3), 235-43.
415. Rowland, M. D., Woolston, J., & Adnopes, J. (2008). Intensive home-based family preservation approaches, including Multisystemic Therapy. In A. Martin, F. R. Volkmar (Eds.), Lewis’s child and adolescent psychiatry: A comprehensive textbook, fourth edition. Baltimore, MD: Lippincott Williams & Wilkins.
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Mental Health Abstracts
15. A consensus: Conclusions of the APA task force report on innovative models of mental health services for children, adolescents, and their families
Summarized and synthesized are recommended systems-level and clinical-level changes advocated within the task force report and by others concerned about the poor condition of mental health services for children. Systems-level changes include recommendations to reduce use of restrictive services, increase the availability of home and community-based services, increase services integration and provider accountability, reform mechanisms for financing services, and train providers in the delivery of more cost-effective services. Clinical-level changes (a) include recommendations to provide more flexible, individualized, and comprehensive services, and (b) emphasize approaches that empower families. Such recommendations are consistent with Stroul and Friedman’s (1986) blueprint for the reform of mental health services for children and the central thrusts of President Clinton'’ Health Security Plan (White House Domestic Policy Council, 1993).
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23. Alternatives to the hospitalization of youth with a serious emotional disturbance
Examined the evidence regarding efficacy, necessity, and outcomes of psychiatric hospitalization for children and adolescents and described recently developed alternatives that are likely to be more ethical and clinically and cost effective.
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29. Families and therapists achieve clinical outcomes, systems of care mediate the process
The absence of significant clinical outcomes from the Fort Bragg Project is not surprising to many treatment outcome researchers. Indeed, a review of the child psychotherapy literature reveals that few treatment approaches have established effectiveness in community settings with youth presenting serious clinical problems. For example, positive child psychotherapy literature reveals that few treatment approaches have established effectiveness in community settings with youth presenting serious clinical problems. For example, positive child psychotherapy effects demonstrated in studies conducted in university settings have rarely been observed in studies conducted in community settings (Weisz & Weiss, 1993; Weisz, Weiss, & Doneberg, 1992). Similarly, with rare exception, treatments of serious antisocial behavior (Henggeler, 1989; Mulverym Arthur, & Reppucci, 1990) and adolescent substance abuse (Henggeler, in press) have not demonstrated long-term effects in randomized clinical trials. Moreover, little empirical support exists for the effectiveness of innovative services such as family preservation (e.g., Rzepnicki, Schuerman, Littell, Chak, & Lopez, 1994) and case management (Burns, Gwaltney, & Bishop, 1995). Thus, if existing treatment models are not clinically effective, why should just the provision of more treatment options to youth in a more coordinated and integrated fashion, as accomplished in the Fort Bragg Project, lead to more positive clinical outcomes?
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30. Innovative approaches for difficult to treat populations
(from the jacket) This book makes recommendations for developing and disseminating innovative mental health services. The book is geared toward clinicians, administrators, and policy makers struggling to develop both clinically effective and cost-effective mental health and substance abuse services. It focuses on services for individuals who use the highest proportion of mental health resources and for whom traditional services have not been effective. These target populations include youth with serious behavioral and emotional disturbances and adults with severe and persistent mental illnesses. The transition from centralized to community-based care is discussed, and normalizing a patient's daily routine as an important factor in the success of state-of-the-art community support programs is emphasized.
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32. Multisystemic therapy: Bridging the gap between university-and community-based treatment
This article proposes, within the context of discouraging findings from child psychotherapy literatures, 2 theory-and empirically based explanations for the emergent success of multisystemic therapy (MST) when implemented in community settings as well as for MST’s favorable long-term effects on serious antisocial behavior in adolescents. First, MST may have demonstrated success in community settings because it explicitly bridges the gap between university-based psychotherapy studies and their community-based counterparts (J.R. Weisz & B. Weiss, 1993). Second, although MST is based on a social-ecological model of behavior, its favorable cross-setting and temporal outcomes may exemplify the successful use of several active behavioral generalization strategies.
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33. Ecological trajectories in child mental health
(from the chapter) This chapter presents a new strategy for dealing with emotional disturbances in children: the ecological method. The ecological viewpoint challenges the traditional, individualistic, "inner treatment" philosophy in mental health and advocates helping the child with emotional disturbance by making changes in the outer, or ecological, factors that influence behavior. The key in the ecological viewpoint becomes identifying and enabling critical environmental trajectories in the child's life. Child clinicians who learn ecological techniques will find that these techniques are flexible enough to let them master new areas of diagnosis and treatment. The techniques will reveal why a child's environment--whether at home, at school, in the town swimming pool, or anywhere else--is a critical factor in effective community mental health treatment.
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35. Innovative services for elderly populations
(from the chapter) Mental illnesses, the emotional consequences of physical disabilities, and the impact of the environment on an aging person's well-being, all pose significant public health problems. A number of community demonstration projects providing long-term care for neuropsychiatrically ill elderly patients using Medicaid and Medicare waivers were funded by the federal government with the goal of reducing institutionalization and controlling the rising costs of long-term care. These projects include social and HMOs, the On Lok program, life-care communities, and The Channeling Demonstration. A brief description of each program and its evaluation is provided.
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36. Research on field-based services: Models for reform in the delivery of mental health care to populations with complex clinical problems
Objective: Clinical services for psychiatrically impaired populations have only recently been studied with significantly valid designs to explore innovations in structure, accessibility, and financing. Health systems reform in the United States has provided the impetus for better defining clinically effective and cost-sensitive models for mental health services. This article reviews assertive community treatment, used for adults with severe mental illnesses, and multisystemic therapy, used for adolescents with serious emotional disturbances, as examples of service system innovations that have been studied with controlled clinical trial designs and have demonstrated efficacy in treating difficult and costly clinical populations. Method: The authors reviewed the published controlled clinical trials of assertive community treatment and multisystemic therapy, focusing on the clinical and administrative elements that distinguish them from traditional service systems. Results: A qualitative assessment of these two approaches suggests that they share common elements, with important implications for mental health policy. Specifically, the use of an ecological model of behavior applied to mental health patients is critical to both systems. In addition, therapeutic principles emphasizing pragmatic (outcome-oriented) treatment approaches, home-based interventions, and individualized goals are key elements of their success. Most important, both systems embody a therapeutic philosophy demanding therapist accountability, in which personnel are rewarded for clinical outcomes and therapeutic innovation rather than for following a prescribed plan. Conclusions: As empirically tested approaches, assertive community treatment and multisystemic therapy provide a specific foundation for continued reform and serve to illustrate critical elements in designing new community treatment initiatives for behavioral as well as medical conditions.
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43. Combining effective treatment strategies with family-preservation models of service delivery
(from the chapter) The primary aims of this chapter are to familiarize psychologists with the family-preservation services literature and to illuminate the important role that psychologists and child and adolescent psychotherapy researchers can play in the development, evaluation, and dissemination of effective family-preservation services for youth with serious clinical problems. Family preservation is described as a model of service delivery through which a variety of counseling and concrete service interventions are implemented in the home and communities of at risk families. The basic assumption underlying most programs is that children and adolescents are better off being raised in their natural families than in surrogate families or institutions. First, the philosophical and programmatic features that distinguish family preservation services from traditional (e.g., inpatient, residential, traditional outpatient) models of mental health service delivery are described, as are the most prevalent "practice models" of family preservation services. Next, research on the effectiveness of family-preservation programs with child welfare, juvenile justice, and "mixed" populations is reviewed, and the implications of these findings for the development of effective family-preservation services for child mental health populations are discussed. Emerging practice models designed specifically for youth with serious clinical problems are described. One of these models, multisystemic therapy (MST), has been empirically validated in several clinical trials and provides a good example of the type of theory- and research-driven approaches that may advance the family-preservation field.
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52. Investigating family-based alternatives to institution-based mental health services for youth: Lessons learned from the pilot study of a randomized field trial
The development and validation of family-based alternatives to out-of-home placements for children is an important goal in the mental health services field. The rigorous evaluation of such alternatives, however, can be difficult to accomplish. The purpose of this article is to describe initial barriers experienced during the pilot study of a randomized trial, funded by the National Institute of Mental Health, conducted in a field setting, and strategies that were used to overcome these barriers. The randomized trial is examining home-based multisystemic therapy as an alternative to the psychiatric hospitalization of youths presenting psychiatric emergencies. The pilot study illuminated the interface of treatment and services research issues, prompting significant changes in the project’s clinical procedures, organization, and supervisory processes, as well as in the project’s interface with exiting community resources for serving youths with serious emotional disturbances.
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53. The cross-ethnic equivalence of measures commonly used in mental health services research with children
The developmental and validation of culturally competent mental health services requires culturally equivalent instrumentation be used in evaluations of such services. Unfortunately, cross-ethnic equivalence has rarely been examined for research instruments commonly used with Black and White children. In a sample of 117 juvenile offenders with diagnosed substance abuse of dependence disorders and considerable psychiatric comorbidities, the present study examined the cross-ethnic equivalence of several measures commonly used by service researchers to tap contextual correlates (i.e., parental symptomatology, family relations, peer relations) of serious emotional disturbance in children. Results indicated that associations between these measures and criterion measures of youth behavior problems and social competence did not vary as a function of ethnicity. Thus, the findings support the cultural equivalence of the measures used in this study; such as, they support the validity of findings from studies that have used these measures with Black and White youth and their families.
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61. Treatment of oppositional defiant disorder and conduct disorder in home and community settings
(from the chapter) Describes treatment approaches deployed in community-based settings for youth with oppositional defiant disorder and conduct disorder that have demonstrated promise in controlled evaluations with clinically representative samples (e.g., inclusive of youth and families from diverse racial backgrounds, experiencing low SES status and living in a variety of family structures). Community-based treatment is described as treatment that is delivered to youth and their caregivers in their indigenous community, in the home or another service setting likely to be available in most communities.
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63. Multisystemic therapy: Changing the social ecologies of youths presenting serious clinical problems and their families
Bronfenbrenner’s (1979) theory of social ecology provides the underlying theoretical rationale of multisystemic therapy (MST). A key assumption of the theory of social ecology is that behavior is multidetermined from the interplay of individual characteristics and the multiple, interrelated systems in which individuals are embedded. For children and adolescents, these systems include the family, peers, school, neighborhood, community (including social support network), and the larger macrosystem (e.g., the organizational culture, political climate). A second assumption is that interpersonal behavior is reciprocal and bidirectional. That is, individuals and systems influence each other in an ongoing and recursive fashion.
The assumptions underlying the theory of social ecology have important clinical implications-implications that are critical to the central thrusts of MST. For example, the first assumption suggests that to understand the determinants of identified problems as well as characteristics of the family, peer, school, and community systems that involve the child. Moreover, the second assumption suggests that multiple vantage points must be considered when determining the “fit” of problems to their systemic context.
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64. Multisystemic therapy versus hospitalization for crisis stabilization of youth: Placement outcomes 4 months postreferral
Hospitalization and out-of-home placement data for 113 youth participating in a randomized trial comparing home-based multisystemic therapy (MST; n = 57) with hospitalization (n = 56) for psychiatric crisis stabilization were analyzed following the completion of MST treatment – approximately 4 months post approval for emergency hospitalization. Analyses showed that MST prevented any hospitalization for 57% of the participants in the MST condition and reduced the overall number of days hospitalized by 72%. Importantly, the reduction in use and length of hospitalization was not offset by increased use of other placement options, as MST reduced days in other out-of-home placements by 49%. The cost implications for the viability of MST as an alternative to hospitalization for youth presenting psychiatric emergencies are discussed.
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68. Treating juvenile offenders in community settings
(from the chapter) The purpose of this chapter is to describe community-based treatment approaches that have demonstrated some promise with juvenile offenders at high risk for mental health problems. Topics include: review of treatments and treatment outcomes (adventure-based programs, behavioral parent training, teaching-family model, individualized/wraparound care, family ties); intensive supervision programs (interventions, specific aims, overall evaluation); and multisystemic therapy.
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79. Identification and treatment of child physical abuse through medical and mental health collaborations
Physically abused children often require medical and mental health services. Professionals from both disciplines should be aware of critical issues related to child physical abuse (CPA) and ways in which they may work collaboratively to identify and treat abuse. In this article we present an overview of prevalence, etiology, identification, and common sequalae associated with CPA. Current psychosocial treatment models are reviewed and challenges and future directions regarding identification and treatment of physical abuse are discussed. The need for collaborative efforts between medical and mental health professionals is emphasized.
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88. Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes
Objective: The primary purpose of this study was to determine whether multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, can serve as a clinically viable alternative to inpatient psychiatric hospitalization. Method: One hundred sixteen children and adolescents approved for emergency psychiatric hospitalizations were randomly assigned to home-based MST or inpatient hospitalization. Assessments examining symptomatology, antisocial behavior, self-esteem, family relations, peer relations, school attendance, and consumer satisfaction were conducted at 3 times: within 24 hours of recruitment into the project, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), and at the completion of MST home-based services (average of 4 months postrecruitment). Results: MST was more effective than emergency hospitalization at decreasing youths’ externalizing symptoms and improving their family functioning and school attendance. Hospitalization was more effective than MST at improving youths’ self-esteem. Consumer satisfaction scores were higher in the MST condition. Conclusions: The findings support the view that an intensive, well-specified, and empirically supported treatment model, with judicious access to placement, can effectively serve as a family- and community-based alternative to the emergency psychiatric hospitalization of children and adolescents.
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217. Psychological impact of fire disaster on children and their parents
Six weeks following a major wildfire, children's psychosocial functioning was examined. Employing a multimethod assessment approach, the short term mental health consequences of the fire were evaluated. Individual adjustment was compared between families who reported high levels of loss as a result of the fire (high-loss group) and families who reported relatively low levels of loss resulting from the fire (low-loss group). Standardized assessment procedures were employed for children and adolescents as well as their parents. In general, high-loss participants reported slightly higher levels of post traumatic stress disorder (PTSD) symptoms and significantly higher scores on the Impact of Events Scale. PTSD symptoms reported by parents were generally significantly correlated with (but nor concordant with) PTSD symptoms reported by their children. The high-loss group scored significantly higher on Resource Loss Index than did the low-loss group. Preexisting and comorbid disorders and previous stressors are described. A methodological framework for future studies in this area is discussed.
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219. Integrating evidence-based substance abuse treatment into juvenile drug courts: Implications for outcomes
This article describes the importance of integrating evidence-based substance abuse treatments into juvenile drug courts. Guidelines from the National Institute on Drug Abuse (NIDA) are offered as a template to enable drug courts to select substance abuse treatments based on available evidence of effectiveness. Multisystemic therapy (MST) is presented as an example of an evidence-based model of treatment that meets NIDA guidelines and has been integrated into several juvenile drug courts. Substance abuse outcomes from published MST trials are summarized, and a current study that examines the relative effectiveness of drug court with MST versus drug court with traditional substance abuse treatment is described.
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227. Aggressive juvenile offenders transitioning into emerging adulthood: Factors discriminating persistors and desistors
Aggressive juvenile offenders (mean age = 15.6 years) were classified as persistors (n = 55) or desistors (n = 25) with aggressive crimes 5 years later (mean age = 20.6 years). At adolescence, desistors engaged in fewer aggressive acts, committed fewer property crimes, and behaved less aggressively and more positively toward peers. At emerging adulthood, desistors reported greater emotional support, higher job satisfaction, closer peer relationships, and fewer psychiatric problems. Findings largely remained significant after initial group differences were controlled.
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228. The elusive concept of cultural competence
Examined agreement statistics (kappas) to access the extent to which 2 groups of experts (those nominated by important peer scholars as having expertise in cultural competence and therapists with extensive experience and training in working with African Americans) agreed on the specific composition of constructs related to cultural competence. Using items from existing psychotherapy process measures, peer-nominated experts indicated whether each item was related to the construct of cultural competence. Therapists with expertise in treating African Americans indicated whether an item fir the same cultural competence categories generated through expert consensus. Peer nominated experts and therapist experts showed poor agreement (kappas) in their classification of which items were relevant to cultural competence. Despite poor overall agreement, however, the groups concurred that a small subset of items were relevant to culturally competent practice with African Americans. These results indicate the need for improved operationalization of the construct of cultural competence.
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247. Multisystemic therapy effects on attempted suicide by youth presenting psychiatric emergencies
Objective: To evaluate the efficacy of multisystemic therapy (MST) in reducing attempted suicide among predominately African American youths referred for emergency psychiatric hospitalization. Method: Youths presenting psychiatric emergencies were randomly assigned to MST or hospitalization. Indices of attempted suicide, suicidal ideation, depressive affect, and parental control were assessed before treatment, at 4 months after recruitment, and at the 1 year posttreatment follow up. Results: Based on youth report, MST was significantly more effective than emergency hospitalization at decreasing rates of attempted suicide at 1-year follow-up; also, the rate of symptom reduction over time was greater for youths receiving MST. Also, treatment differences in patterns of change in attempted suicide (caregiver report) varied as a function of ethnicity, gender, and age. Moreover, treatment effects were found for caregiver-rated parental control but not for youth depressive affect, hopelessness, or suicidal ideation. Conclusions: Results generally support MST's effectiveness at reducing attempted suicide in psychiatrically disturbed youngsters, whereas the effects of hospitalization varied based on informant and youth demographic characteristics. J. Am. Child Adolescent Psychiatry, 2004; 43(2): 183-190. Key Words: attempted suicide, multisystemic therapy, hospitalization, treatment moderators.
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251. Heterogeneity in youth symptom trajectories following psychiatric crisis: Predictors and placement outcomes
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.
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252. Multisystemic therapy with youth exhibiting significant psychiatric impairment originally developed to address serious antisocial behavior in juvenile offenders
(Henggeler & Borduin, 1990; Henggeler et al., 1986), multisystemic therapy (MST) is an intensive home-and community–based intervention grounded in social ecological theories of behavior (Bronfenbrenner, 1979). MST interventions are designed to target the known determinants (Elliott, Huizinga, & Ageton, 1985; Loeber & Farrington, 1998) of youth antisocial behavior in the natural ecology. Substantial evidence supports the effectiveness of MST for delinquent youth. Three randomized trials established the short-and long-term effectiveness of MST in reducing youth antisocial behavior, arrests, and incarceration (Borduin et al., 1995; Henggeler, Melton, Brondino, Scherer, & Hanley, 1997; Henggeler, Melton, & Smith, 1992; Henggeler, Melton, Smith, Schoenwald, & Hanley, 1993). Since then, several studies of the effects of MST on youth antisocial behavior have been conducted by independent researchers (Leschied & Cunningham, 2001; Satin, 2000). Central to MST-related research, the Family Services Research Center (FSRC) at the Medical University of South Carolina (Scott Henggeler, director) has been conducting federally funded programmatic research on MST and other community based interventions since 1992. The foci of current projects within the FSRC are the transportability and dissemination of empirically validated treatments, including-but not limited to-MST, and modifications of MST for populations of youth presenting other serious problems. Subsumed under the latter category are randomized trials of MST modified to treat youth with (a) delinquency and substance use disorders (SUDS) (Randall, Henggeler, Cunningham, Rowland, & Swenson, 2001), (b) insulin-dependent diabetes complicated by poor medication compliance (Ellis, Naar-King, Frey, Rowland, & Gregor, 2004), (c) abusive and neglectful families (Kolko & Swneson, 2002), (d) sexual offending behaviors (Swenson, Henggeler, Schoenwald, Kaufman, & Randall, 1998), and (e) serious mental health problems (Henggeler, Schoenwald, Rowland, & Cunningham, 2002).
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253. Treatment costs for youths receiving multisystemic therapy or hospitalization after a psychiatric crisis
Objectives: The authors conducted a cost analysis for Multisystemic therapy, an evidence-based treatment that is used as an intensive community-based alternative to the hospitalization of youths presenting with psychiatric emergencies. Methods: Data from a randomized clinical trial that compared Multisystemic therapy with usual inpatient services followed by community aftercare were used to compare Medicaid costs and clinical outcomes during a four-month period post referral and a 12-month follow-up period. Data were from 115 families receiving Medicaid (out of 156 families in the clinical trial). Results During the four months postreferral, Multisystemic therapy demonstrated better short-term cost-effectiveness for each of the clinical outcomes (externalizing behavior, internalizing behavior, and global severity of symptoms) than did usual inpatient care and community aftercare. The tow treatments demonstrated equivalent long-term cost-effectives. Conclusions: Among youths presenting with psychiatric emergencies, Multisystemic therapy was associated with better outcomes at a lower cost during the initial postreferral period and with equivalent cost and outcomes during the 12-month follow-up period.
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260. Community-based treatments
Recent syntheses of intervention research have concluded that treatments for juvenile delinquency procedure quite divergent results, but that community-based treatments are showing greater promise than most other approaches. For example, Lipsey and Wilson’s 1998 meta-analysis of intervention studies for serious juvenile offenders found an overall average effect size of .12 for recidivism, indicating a difference between treatment and control groups of only about one tenth of a standard deviation unit. However, effect sizes ranged from as high as .52 (i.e., one half of a standard deviation unit) to as low as -.17 (i.e., the treatment group fared worse than the control group). Likewise, other recent reviews have supported the view that community-based interventions are the most promising treatments available for juvenile offenders. For example, of the more than 500 programs reviewed in the Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) Blueprints for Violence Prevention Initiative (Mihalic, Irwin, Elliott, Fagan, & Hansen, 2001), the model programs identified as effective for treating juvenile offenders were all family- and community-based. This chapter examines the community-based treatment models for juvenile offending that have established effectiveness or are promising. Specifically, brief summaries of their clinical procedures, findings from clinical trials, and cost related outcomes are provided. In addition, parallels among these community-based models and corresponding implications for clinical practice and future research are discussed.
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262. A randomized trial of multisystemic therapy with Hawaii’s celix class youths
Examined 6-month post-recruitment clinical and placement outcomes for 31 youths with serious emotional disturbance (SED) at imminent risk of out-of-home placement in the Hawaii Continuum of Care (COC). Youths were randomly assigned to multisystemic therapy (MST) adapted for SED populations or to Hawaii’s existing COC services. Assessments were conducted at intake and 6 months after referral. In comparison with counterparts in the comparison condition, youths in the MST condition reported significant reductions in externalizing symptoms, internalizing symptoms, and minor criminal activity; their caregivers reported near significant increases in social support; and archival records showed that MST youths experienced significantly fewer days in out-of-home placement. The findings generally replicate the favorable short-term outcomes observed previously for MST with youths experiencing SED.
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274. Predictors of treatment response for suicidal youth referred for emergency psychiatric hospitalization
This study evaluated factors that predicted poor treatment response for 70 suicidal youth (ages 10 to 17 years; 67% African American) who received either multisystemic therapy (MST) or inpatient psychiatric hospitalization. Following treatment, suicidal youth were classified as either treatment responders or nonresponders based on caregiver or youth report of attempted suicide. Overall, female gender, depressive affect, parental control, caregiver psychiatric distress, and caregiver history of psychiatric hospitalization were associated with suicide attempts. However, controlling for other variables, only depressive affect and parental control predicted treatment non-response. These results suggest the need to adapt existing treatments for suicidal youth to better address problems relating to youth depression.
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303. Outcomes from wraparound and multisystemic therapy in a center for mental health services system-of-care demonstration site
This study examined outcomes for 320 youth in a Center for Mental Health Services system-of-care demonstration site. Youth received wraparound-only (n = 213), MST-only (n = 54), or wraparound + MST (n = 53). Participants were 12 years old on average and mostly White (90%), and 75% were Medicaid-eligible. Service use and functional and clinical outcomes were examined at 6-month intervals out to 18 months. All three groups improved over the study period. The MST-only group demonstrated more clinical improvement than the other groups. Functional outcomes did not differ significantly across groups. Youth in wrap + MST had higher baseline severity and experiences less clinical and functional change than the other two groups, despite more mental health services use. Targeted, evidence-based treatment may be more effective than system-level intervention alone for improving clinical symptoms among youth with serious emotional disorders served in community-based settings. New or amended approaches may be needed for youth with the most severe disorders.
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328. The relation of antisocial behavior patterns and changes in internalizing symptoms for a sample of inner-city youth: Comorbidity within a developmental framework
Research examining the relationship between internalizing symptoms and antisocial behaviors has generally been cross-sectional in design. Thus, although extant data have substantiated a strong correlation between internalizing symptoms and antisocial behaviors, few studies have focused on describing the nature of the co-occurrence over time. This study examined the relation between growth in internalizing symptoms and longitudinal patterns of antisocial behavior in a sample of 283 inner-city males and their caregivers assessed as part of a longitudinal developmental risk study. Participants were assessed annually in four waves. Non-offenders and escalating offenders had lower levels of internalizing problems at wave 1 than did chronic minor and serious-chronic-violent offenders. Results revealed a developmental trend of decreasing internalizing problems across study years for most participants , as would be expected, with adolescents participating in serious, chronic, and violent patterns of antisocial behavior displaying greater internalizing problems than those participating in stable patterns of less serious or no antisocial behavior. Further, when there was escalation of seriousness and frequency of antisocial behavior, there also was increased internalizing problems relative to non-escalating juveniles. Results are discussed in the context of developmental psychopathology.
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340. An ecological model of school-based mental health services: Enhancing schools' capacity to support children in poverty
School based mental health services for children in poverty can apitalize on schools' inherent capacity to support development and bridge home and neighborhood ecologies. We propose an ecological model informed by public health and organizational theories to refocus school based services in poor communities on the core function of schools to promote learning. We describe how coalescing mental health resources around school goals includes a focus on universal programming, mobilizing indigenous school and community resources, and supporting core teaching technologies. We suggest an iterative research-practice approach to program adaptation and implementation as a means toward advancing science and developing healthy children.
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