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Complex trauma is a significant public health problem in the United States (U.S.), occurring in families with chronic and compounding exposures to traumatic stressors like substance misuse, intimate partner violence (IPV) and child maltreatment (Cook et al., 2017). Yet, few programs exist to treat their intersection, challenging our ability to respond effectively and restore positive trajectories for children and families. In this context, there is a need for innovative approaches to treat these intersecting phenomena. In this conceptual paper, we identify three innovative programs that offer integrative approaches to these intersecting challenges. We analyze common elements among these programs, offering a theoretical foundation for fundamental elements of transformative services. Finally, we consider how the Families First Prevention Act could be leveraged for states to adopt and implement these programs. The goal of this conceptual paper is to advance empirical and practical discussions regarding programmatic and policy options for more effectively responding to substance misuse, and IPV in families, and the associated traumas incurred by maltreated children and their caregivers. • Substance misuse, IPV, and child maltreatment, frequently co-occur. Yet, few programs exist to address their inter-related effects. • This conceptual paper reviews three exemplar integrative programs: Child Development Community Policing, Family-Based Recovery, and Child Parent-Psychotherapy. • We identify key and common elements of these integrative programs. Specifically, we find that: 1 warm handoffs, 2) removing barriers to access, 3) relationship-based practice, 4) a trauma-informed approach, 5) strong case management, 6) providing access to services when families are in crisis, and 7) breaking down silos are important components for integrated approaches. • The federal Family First Prevention Act (FFPSA) could be leveraged to fund innovative, integrative approaches to substance misuse, intimate partner violence, and child maltreatment. • Integrative programs are important for promoting resilience and restoring positive trajectories for children and families. [ABSTRACT FROM AUTHOR]

In this paper, the authors present a brief personal account of the senior author's 30 years of exploration in behavioral gerontology. The main thesis of the paper is that behavioral methods and interventions have found a home both in mainstream gerontology and at the National Institutes of Health (NIH). There are three sections: (a) a personal vignette discussing the problems inherent in using operant terminology in a nonoperant world; (b) a discussion, with examples from NIH sources, of the Institutes' views on behavior change; and (c) using Burgio and Burgio (1986) as a reference point, the authors show evidence of progress and vitality of behavioral gerontology in 2011. [ABSTRACT FROM AUTHOR]

This paper presents a methodology for estimating costs of delivering specific substance abuse treatment services. Data collected from 13 programs indicate that the mean cost of residential treatment is $2,773 per patient per month, and outpatient treatment costs average $636 per patient per month. Data are presented on the cost patient per month for individual treatment and nontreatment services, average number of services, cost per unit of service, and intensity of services. In addition to their application to insurance benefit cost estimation, these data illustrate the costing of best-practice adolescent treatment consistent with a Center of Substance Abuse Treatment (CSAT) Treatment Improvement Protocol. In the emerging policy environment, detailed cost estimates like these will aid the design of cost-effective treatment programs, and serve the development of the substance abuse benefit in a health care reform insurance package. [ABSTRACT FROM AUTHOR]

Contemporary person-centered psychotherapy often references empathy as a basic component of the therapeutic alliance and, thus, effective treatment, such that nascent clinicians study this basic skill early in training. However, the psychotherapy literature often presumes a collective agreement about how empathy manifests as a clinical tool, in the process institutionalizing the ideal of omnipresent alignment with a client, applied across populations of patients, regardless of their conditions, ages, and personal and cultural characteristics. Misalignments between clinicians and clients have the potential to bely broadly imagined ethics of empathy (and the notion of collective agreement about what it is) by demonstrating the ways tension, difference, and incongruence promote treatment. Through an autoethnography of a 12-month psychotherapy dyad with an elderly woman committed for treatment at a U.S. psychiatric hospital, we discuss how moments of incongruence between clinician and client expand conceptualizations of empathy in treatment of psychosis. Specifically, in this context, deployment of empathy-as-alignment becomes a fallacy of care, risking the effectiveness of treatment through impossible epistemological assumptions of and counterproductive joining with the client. As such, this transtheoretical discussion presents two types of incongruence in the dyad—developmental and subjective—as a backdrop for expressing empathy. This paper makes space for a theory of empathy as the practice of working in genuine and careful service of the client's psychology through acts of incongruence as much as alignment. • Definition of the construct of empathy lacks consensus in the clinical literature. • Clinicians may struggle struggle to empathize with the life stage and extra-realistic perceptions of elderly clients with psychosis. • Unavoidable elements of incongruence between clinician and client do not need to point to empathic failure. • Use of incongruence through metaphor and radical genuineness may build experiences of empathy and the therapeutic alliance. • Empathy may be delineated as both affective and cognitive affirmation and as shifts between congruence and incongruence. [ABSTRACT FROM AUTHOR]