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The authors quantified the impact of the use of telehealth services on patient-level clinical outcomes among children with complex behavioral and emotional needs in Idaho during the COVID-19 pandemic by comparing data collected in 2020 with data for the same months in 2019.Longitudinal statewide data of Child and Adolescent Needs and Strengths (CANS) assessments were extracted from Idaho's mental and behavioral health system. Prepandemic assessments were matched to midpandemic assessments. A linear mixed-effect model was used to explore four child-level outcomes: psychosocial strengths-building rate, rate of need resolution within a life-functioning domain, rate of need resolution within a behavior-emotional domain, and rate of need resolution within a high-risk behaviors domain.The number of new patients admitted to Idaho's state-funded mental and behavioral health program decreased almost twofold from April-December 2019 to April-December 2020 (N=4,458 vs. 2,794). For most children with complex needs, the use of telehealth was as effective in terms of strengths building and needs resolution as in-person services; for children whose caregivers had issues with access to transportation, availability of telehealth services improved outcomes for the children.The COVID-19 pandemic in 2020 was associated with a dramatic drop in the number of children served by Idaho's mental health program. Telehealth may effectively bridge mental health service delivery while patients and providers work toward the resolution of transportation issues or may serve as a more acceptable permanent format of service delivery for some populations.

This article analyses the improvement of cotton-spinning technologies in the years after the great inventions of Hargreaves, Arkwright, and Crompton. While these ‘macro-inventions’ have attracted considerable historical attention, our understanding of the major changes in types and sizes of spinning machines used in the UK between the 1780s and the onset of state-collected factory statistics in the 1830s is still largely based on the experience of high-profile firms or specific technologies and regions. A new dataset of 1,465 machinery advertisements published in newspapers in England, Scotland, and Ireland between 1780 and 1835 allows us to examine the temporal and spatial dimensions of the market for cotton-spinning machinery, the timings of transitions between different spinning machines, and increases in machine size. The article demonstrates the importance of post-invention technical improvements in the cotton industry, showing that the productivity increases associated with the initial transition from hand to machine spinning have been overstated and that larger gains were made in the ‘micro-invention’ phase, when spinning machines became larger and faster, and required fewer workers to operate them.

ObjectiveTo develop and test predictive models of admissions to a psychiatric residential treatment facility (PRTF) in transitional age youth using routinely collected health insurance claims and enrollment data.Data SourcesWe used outpatient service and pharmaceutical claims from Medicaid beneficiaries aged 6-to 21-years old in Kentucky for the years 2010-2017.Study DesignWe assessed over 1,250 predictors (derived from Medicaid claims data) prior to the first PRTF admission. An ensemble machine learning (ML) algorithm based on logistic regression models fitted to a random subsample of the original data was used to predict pathways to the first PRTF admission. Discrimination performance of the ML ensemble was evaluated by comparing predictions to actual outcomes and calculating area under the curve (AUC), accuracy, sensitivity, and specificity. Additionally, a multivariate logistic regression model was fit to investigate the contribution of the continuity of mental health care after the initial PRTF admission on the risk of readmission.Data Collection/Extraction MethodsWe identified N = 519,011 unique children and youth with at least one outpatient service or pharmaceutical claim during our study period (January 1, 2010 through December 31, 2017).Principal FindingsFewer than 0.5% of children and youth in Kentucky had an episode of PRTF admission. Despite a very low prevalence of PRTF admission, classification accuracy of the ML ensemble for identifying PRTF youth achieved over 90% accuracy (AUC = 0.96). Factors associated with the initial PRTF admission were having been prescribed anti-psychotic and anti-manic medications, and receiving outpatient psychiatric care. Within six months after the initial PRTF discharge, there was a surprising drop in service utilization with a large proportion of youth not appearing to receive any follow-up care.ConclusionsDespite the fact that admission into a PRTF was a relatively rare event, our findings suggest that it is a predictable event among youth with identified mental health conditions who are receiving care in the community.What is known on this topicAfter psychiatric hospitalization, PRTF treatment is the most expensive and restrictive intervention available to serve children and youth.Previous research examining predictors of PRTF entry using Medicaid reimbursement data showed that clinical factors were strong predictors of hospitalization.What this study addsWe provide a comprehensive analysis of the factors beyond clinical diagnoses that lead to PRTF entry.We also seek to identify whether any specific patterns of service and/or pharmacy claims utilization are associated with reducing the likelihood of readmission.

Surveys, questionnaires, and assessments are the only approved means for measuring outcomes, yet there is a paucity of evidence that these tools can perform well as outcomes measures. A major barrier to utilizing these tools as measures of improvement in care is an inability to recognize when the responses are incomplete, inaccurate, or insincere. In this study, we propose a hybrid unsupervised-supervised approach to identify inauthentic assessments via anomalous response patterns. The study utilized 60-question behavioral assessment from a clinical population served by a county-operated public children’s behavioral health services (n = 42,945). A novel hybrid unsupervised-supervised approach was developed to identify inauthentic assessment records from highly dimensional assessment data without the need for a priori record labels, which would otherwise require countless hours of record review by highly trained clinical staff. A neural network trained with 75% of the labeled data recognized anomalous response patterns in the test data with 84.5% sensitivity and 97.3% specificity. The model identified 26% of records as potentially inauthentic based on anomalous response patterns. For mental health and behavioral health, this novel method could flag a relatively small proportion of the records for clinical review while allowing records with probable authenticity to bypass review processes, saving time and creating efficiency in care. This method is also a potential tool for improving service quality through the identification of circumstances that have been overlooked but could otherwise be addressed during care. For decades, assessment data has been collected by policy and ignored by practice due to limitations of utility. With the right approaches, we could uncover the patterns of what works for whom that are currently hidden in our existing assessments.

PurposeThe purpose of this paper is to argue that defining, measuring and developing skills are crucial to successful entrepreneurship and that being able to do so can help to build strong rural entrepreneurial ecosystems.Design/methodology/approachThe literature on entrepreneurship success and entrepreneurial skills is reviewed, and this knowledge is used to create and describe the Entrepreneurship Skill-building Framework (ESBF), which provides a scaffold for thinking about the identification, measurement and development of essential entrepreneurship skills. The same literature is used to develop a tool for effectuating the ESBF, called the Readiness Inventory for Successful Entrepreneurship (RISE), which assesses entrepreneurship skills using the communimetrics theory of measurement.FindingsBoth the ESBF and the RISE are detailed, and they are applied to the successful development and maintenance of rural entrepreneurial ecosystems, with an example from practice. Specific implications for rural entrepreneurship-focused economic development are also discussed.Originality/valueThe ESBF represents a new way of framing entrepreneurship skills and their development. The RISE is a skills assessment tool that is clinical, not predictive, utilizing an innovative theory of measurement. Together, they offer a fresh approach to thinking about the purpose and effective implementation of entrepreneurial ecosystems.

Transportation to/from care is a significant barrier to healthcare access and utilization. The novel coronavirus pandemic prompted a widespread expansion of telehealth service delivery throughout much of 2020. We used propensity score matching to generate two comparison groups of children served in a large public mental and behavioral health system between (1) April-December 2019 (pre-pandemic; n=2,794), and (2) between April-December 2020 (during the COVID-19 pandemic, n=2,794), followed by longitudinal linear mixed-effects modelling to explore the relationship between caregiver transportation needs and child-level outcomes. Our analyses indicated a statistically significant association between the resolution of caregiver’s transportation needs and children’s clinical improvement in the 2019 (pre-pandemic) sample; there was no such association found in the 2020 (pandemic) sample. Our findings suggest that the use of telehealth may mitigate the effect of caregiver transportation needs on child-level clinical outcomes.

Objective The adult INTERMED is used to determine case complexity and psychosocial needs. We developed and validated a pediatric version of the INTERMED for children and adolescents with inflammatory bowel disease (IBD) and assessed its utility in predicting healthcare utilization. Methods We performed a cross-sectional study of children (aged 8–17 y) with IBD (n = 148) and their parents, seen in a hospital-based clinic. Subjects completed semi-structured interviews that were scored on the 34 pIBD-INTERMED items. To assess inter-rater reliability, 40 interviews were videotaped and scored by a second assessor. Convergent and predictive validity were assessed by examining the relation of the pIBD-INTERMED to standardized measures of psychological, social, and family functioning, disease activity, and healthcare utilization. Results Correlational analyses supported the validity of all five pIBD-INTERMED domains with very good inter-rater reliability (median r = 0.87) and internal consistency (α = 0.91) for the total complexity index. Ratings of 2–3 on the pIBD-INTERMED “mental health/cognitive threat” item were associated with greater odds of behavior and social problems (CBCL-Internalizing scale OR = 7.27, 95% CI 2.17–24.36); CBCL-Externalizing scale OR = 24.79, 95% CI 5.00–122.84), depression (Children's Depression Inventory OR = 8.52, 95% CI 1.70–43.02) and anxiety (Multidimensional Anxiety for Children OR = 11.57, 95% CI 3.00–45.37). The pIBD-INTERMED complexity index added significantly to the prediction of healthcare utilization, beyond the contribution of disease severity. Conclusions The pIBD-INTERMED is a reliable and valid tool for identifying psychosocial risks and needs of children with IBD. It can be used to guide planning of individualized care and enhance interdisciplinary pediatric IBD care.

Introduction Despite a rich and developing research literature on the relationships between transportation and healthcare outcomes, the impact of unmet transportation needs on children, particularly on their general psychosocial functioning, is less well understood. We hypothesized that caregiver's transportation needs may be a key point of intervention for child-level health outcomes, such that the resolution of caregiver transportation needs may have an important, downstream impact on other areas of the child's functioning. Methods We tested this hypothesis in a sample of children (n=4341) served in a large, statewide public behavioral healthcare system. We conducted a retrospective longitudinal analysis of children served in the system between March 2019 and March 2020, using a specialized assessment tool that captures a comprehensive range of psychosocial functioning: the Child and Adolescent Needs and Strengths (CANS; Lyons, 2009) assessment. Results Linear mixed-effects analyses demonstrated that, if caregivers’ transportation needs were resolved during the episode of care, those children demonstrated greater improvements on both need reduction and strength building across multiple domains than did their peers whose caregivers had unresolved transportation needs. By the end of the episode of care, children whose caregivers had resolved transportation needs were not significantly different than those children whose caregivers never had transportation needs. Conclusions The resolution of transportation needs may be an important focus for providers working with children with a complex behavioral health, such that the resolution of these transportation needs seems to have a large, positive downstream impact on their overall functioning.

This chapter discusses the use of the RISE by the Scheinfeld Center for Entrepreneurship and Innovation at Santa Barbara City College. It describes the Center’s mission, vision, programming, student body, and facilities. The Center has been using the RISE assessment in its Get REAL Accelerator program and in its Scheinfeld Interns Program. The chapter shares how the assessment was implemented and provides quantitative and qualitative measures of the outcomes. In addition, it discusses the use of the RISE in the Introduction to Entrepreneurship course, which brought the assessment into the curriculum, familiarizing students with the tool and its capability for enhancing their educational experience, creating a pipeline of students who can take full advantage of this capability through the programs of the Center.

This chapter discusses major recent changes in the way we think about entrepreneurs and how they are developed. It begins with the idea that entrepreneurs are born, not made, and how that theory influenced entrepreneurship education and policy, until it was largely debunked through research, shifting thinking toward the development of entrepreneurs. Along the way, entrepreneurship educators moved away from business plans and planning processes toward customer discovery and business modeling. Entrepreneurship is now thought of as a method, requiring a skill set to be executed successfully.

In this chapter, we lay out a conceptual framework for a skill development perspective to entrepreneurship development. We argue that entrepreneurship development should be considered a transformational offering that requires mass customization. Developing entrepreneurs necessitate a skills-based complex system. For this purpose, we describe a conceptual framework for managing such a system called Transformational Collaborative Outcomes Management (TCOM), which comes from the helping professions, particularly behavioral health. We elaborate its five-stage process—access, assessment and engagement, intervention planning and delivery, monitoring and adapting, coordination and care management, and transitioning—and adapt this to the entrepreneurship development process.

The Entrepreneurship Program in the Gary W. Rollins College of Business at the University of Tennessee at Chattanooga is using the RISE to help it implement a strategy that focuses on building the entrepreneurship skills of its students. It is taking its long-standing curriculum and closely integrating it with the co-curricular activities of its new Center for Innovation and Entrepreneurship. The result is an interesting set of unique practices that reinforce the knowledge imparted in the classroom in a way that strategically facilitates skill building.

Entrepreneur development programs have many choices in terms of how they might elect to measure skills. However, any program that conceptualizes entrepreneurship as a set of skills must make this decision. In order to remain consistent with the TCOM framework and create an efficient and collaborative assessment process, we have created the Readiness Inventory for Successful Entrepreneurship (RISE).To achieve the aspirations of TCOM we have used the communimetric measurement theory. In this chapter we describe this theory and contrast it to traditional theories of measurement. We then describe the development, structure and uses of the RISE.

In this chapter, we will take up the application of the clinical assessment tool called the RISE to the education of students of entrepreneurship. We will pick up on the discussion of the current model of entrepreneurship education begun in Chapter 1, exploring learning theory, both curriculum and co-curricular activities, and where the RISE might fit into this flow. We will look at the application of outcomes management principles to skill building efforts in entrepreneurship education. Finally, we will examine how the RISE has been modified and extended over the course of its development and the implications of this for its use in the entrepreneurship education arena.

ObjectivesThe goal of this study was to examine the mental health needs of children and youth who present to the emergency department (ED) for mental health care and to describe the type of, and satisfaction with, follow-up mental health services accessed.MethodsA 6-month to 1.5-year prospective cohort study was conducted in three Canadian pediatric EDs and one general ED, with a 1-month follow-up post-ED discharge. Measures included 1) clinician rating of mental health needs, 2) patient and caregiver self-reports of follow-up services, and 3) interviews regarding follow-up satisfaction. Data analysis included descriptive statistics and the Fisher’s exact test to compare sites.ResultsThe cohort consisted of 373 children and youth (61.1% female; mean age 15.1 years, 1.5 standard deviation). The main reason for ED presentations was a mental health crisis. The three most frequent areas of need requiring action were mood (43.8%), suicide risk (37.4%), and parent-child relational problems (34.6%). During the ED visit, 21.6% of patients received medical clearance, 40.9% received a psychiatric consult, and 19.4% were admitted to inpatient psychiatric care. At the 1-month post-ED visit, 84.3% of patients/caregivers received mental health follow-up. Ratings of service recommendations were generally positive, as 60.9% of patients obtained the recommended follow-up care and 13.9% were wait-listed.ConclusionsChildren and youth and their families presenting to the ED with mental health needs had substantial clinical morbidity, were connected with services, were satisfied with their ED visit, and accessed follow-up care within 1-month with some variability.

The evidence-base services literature is continually growing, providing the field with rich and important sets of information regarding what works for treating different types of youth and families. Given this burgeoning of information, the PracticeWise Evidence-Based Services (PWEBS) Literature Database has been developed to aid in summarizing and delivering aggregated evidence-based treatment information to providers in the field. Meanwhile, the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) Scale is a youth mental health assessment tool that was developed by a separate team to assist with treatment planning. In the present study, we developed and tested a system for linking these two related ontological systems so that scientific knowledge can be more widely aggregated and made available to a wider set of audiences for enhanced mental health service delivery. Results revealed the following. First, a construct mapping comparison revealed that the CANS-MH and PWEBS ontologies share a strong core of overlapping content, particularly in the areas of Youth Behavioral/Emotional Needs, Youth Risk Behaviors, and Life Domain Functioning. Second, the CANS-MH areas were able to be used to reliably code the following components of published randomized treatment studies: (a) population sample characteristics (e.g., did the characteristics of the treatment study participant population relate to each CANS-MH area?), and (b) outcome measure targets (e.g., did the treatment study outcome measure target areas relate to each CANS-MH area?). The reliability achieved from this coding process supported the linkage between the CANS-MH areas and the PWEBS Literature Database information. Lastly, high agreement was achieved between an automated translation algorithm and the final ratings from the manual coding of published treatment studies using the CANS-MH scale. The importance of such linkages for the communication of ideas, information, and evidence across differing subfields is discussed, as well as examples of achieving enhanced quality of mental health services by linking system ontologies.

Traditionally, clinical recommendations for assessing and managing paediatric obesity have relied on anthropometric measures, such as body mass index (BMI), BMI percentile and/or BMI z-score, to monitor health risks and determine weight management success. However, anthropometric measures do not always accurately and reliably identify children and youth with obesity-related health risks or comorbidities. The authors propose a new clinical staging system (the Edmonton Obesity Staging System for Pediatrics, EOSS-P), adapted from the adult-oriented EOSS. The EOSS-P is used to stratify patients according to severity of obesity-related comorbidities and barriers to weight management into four graded categories (0 to 3) within four main health domains: metabolic, mechanical, mental health and social milieu (the 4Ms). The EOSS-P is based on common clinical assessments that are widely available and routinely completed by clinicians, and has the potential to provide clinical and prognostic information to help evaluate and inform the management of paediatric obesity.D’ordinaire, les recommandations cliniques pour évaluer et prendre en charge l’obésité juvénile reposent sur des mesures anthropométriques, telles que l’indice de masse corporelle (IMC), le percentile d’IMC ou l’écart réduit de l’IMC, pour surveiller les risques sur la santé et déterminer la bonne gestion du poids. Cependant, les mesures anthropométriques ne permettent pas toujours de déterminer avec précision et fiabilité les enfants et les adolescents présentant des risques de santé ou des comorbidités liés à l’obésité. Les auteurs proposent un nouveau système clinique d’établissement du stade de l’obésité (le système d’Edmonton pour évaluer le stade de l’obésité, ou EOSS-P), adapté de l’EOSS destiné aux adultes. L’EOSS-P est utilisé pour stratifier les patients selon la gravité des comorbidités liées à l’obésité et les obstacles à la gestion du poids en quatre catégories (0 à 3) tirées de quatre grands domaines de santé : métabolique, mécanique, santé mentale et milieu social (les 4M). L’EOSS-P, qui repose sur des évaluations cliniques courantes généralisées souvent remplies par les cliniciens, peut fournir de l’information clinique et pronostique pour contribuer à évaluer et étayer la prise en charge de l’obésité juvénile.

While the child serving system has been measuring and monitoring outcomes for more than three decades, the promise of actually using outcomes to support changes in the functioning of the system has not yet lived up to its full potential. In this Editorial, I review what I believe to be a number of ways that we have mistakenly conceptualized outcomes. By working through these myths, we can begin to teach the system to learn from its own experiences to better help child and families.

In order to understand the differential presentation of trauma stress symptoms over the course of development from children to adolescents, a sample of more than 11,000 children and adolescents were studied who were identified as to whether they had experienced multiple trauma experiences prior to placement in child welfare custody. Six age groups were compared on their presentation of symptoms associated with traumatic experiences. Trauma stress symptoms were dramatically different for children and adolescents despite the similarity of trauma experiences. Implications for understanding and addressing multiple trauma experiences across a developmental trajectory are discussed.

After children enter the child welfare system, subsequent out-of-home placement decisions and their impact on children’s well-being are complex and under-researched. This study examined two placement decision-making models: a multidisciplinary team approach, and a decision support algorithm using a standardized assessment. Based on 3,911 placement records in the Illinois child welfare system over 4 years, concordant (agreement) and discordant (disagreement) decisions between the two models were compared. Concordant decisions consistently predicted improvement in children’s well-being regardless of placement type. Discordant decisions showed greater variability. In general, placing children in settings less restrictive than the algorithm suggested (“under-placing”) was associated with less severe baseline functioning but also less improvement over time than placing children according to the algorithm. “Over-placing” children in settings more restrictive than the algorithm recommended was associated with more severe baseline functioning but fewer significant results in rate of improvement than predicted by concordant decisions. The importance of placement decision-making on policy, restrictiveness of placement, and delivery of treatments and services in child welfare are discussed.

There is a substantial body of research on delinquent behavior and symptoms of conduct disorder among young males; however, less attention has been dedicated to understanding the female population. The aim of this study is to examine young girls’ severity of needs related to conduct disorder and delinquent behavior in relation to various past traumatic experiences. We hypothesized that for girls the presence of these needs will be correlated with physical and sexual abuse. Furthermore, we propose the relationship of trauma to conduct-related needs will be higher among females as compared to males. Data were collected on 1,479 girls ages 12–18 who entered into state child welfare custody. Each participant has been assessed using the Child and Adolescent Needs and Strengths (CANS), which helps identify mental health needs and strengths of every youth. Results show partial support for the hypothesis that sexual abuse has a significant correlation with conduct disorder symptoms; however, physical abuse showed...

Despite decades of eating disorder (ED) research, studies of factors involved in long-term EDs are still lacking. This longitudinal study investigated the role of maintenance variables in a transdiagnostic adolescent ED sample. Participants included 275 adolescents who underwent specialized ED treatment. Hierarchical linear modeling confirmed a significant growth pattern of maintenance factors, wherein there was initial increase, then a decline during treatment, followed by a slight rebound post-treatment. Refractory status did not predict the variability in maintenance curves, suggesting that although this growth pattern existed, requiring a second treatment encounter did not explain the differences found in these patterns.

Residential treatment is the most intensive and costly component of all child welfare systems per episode of care. At the same time, decisions to place in residential treatment centers are prioritized by the practice of least restrictive setting and best interest for children. There are, however, no standard evidence-based criteria for placing children in residential treatment. Clinical judgment, staffing dynamics, and other system factors are part of the decision-making process. Thus, some residential placements may be unnecessary and may be even harmful. The present study compares two models of decision-making, a multidisciplinary team approach and an objective decision support algorithm, and assesses outcomes when the two models either concur or not. Concordant decisions predicted greater clinical improvement than discordant decisions, but no differences were found in length of stay in placement. Policy implications for the decision-making process in child welfare are discussed.

none 32 si The International Work Group for Therapeutic Residential Care convened an International Summit on ‘Pathways to Evidence-Based Practice’ at Loughborough University (GBR), Centre for Child and Family Research on 27-29 April, 2016 with generous support from the Sir Halley Stewart Trust and in partnership with The European Scientific Association on Residential and Family Care for Children and Adolescents (NLD) (EUSARF), the International Association for Outcome-Based Evaluation and Research on Family and Children’s Services (ITA) (IAOBER) and the Association of Children’s Residential Centers (USA) and with the additional support of Action for Children (GBR) and the National Implementation Service (NIS) (GBR). Membership includes: Lisa Holmes (Chair), Director, Centre for Child and Family Research, Loughborough University (GBR); James K. Whittaker (Co-Chair), Charles O. Cressey Endowed Professor Emeritus, University of Washington, School of Social Work, Seattle (USA); Jorge Fernandez del Valle, Professor of Psychology and Director, Child and Family Research Group, University of Oviedo (ESP); Frank Ainsworth, Senior Principal Research Fellow (Adjunct), James Cook University, School of Social Work and Human Services, Townsville, Queensland (AUS); Tore Andreassen, Psychologist, The Norwegian Directorate for Children, Youth and Family Affairs (NOR); James P. Anglin, Professor, Faculty of the School of Child and Youth Care, University of Victoria (CAN); Christopher Bellonci, Board-Certified Child/Adolescent and Adult Psychiatrist; Associate Professor, Psychiatry Department, Tufts University School of Medicine, Boston, MA (USA); David Berridge, Professor of Child and Family Welfare, School for Policy Studies, University of Bristol (GBR); Amaia Bravo, Lecturer, Department of Psychology, University of Oviedo (ESP); Cinzia Canali, Senior Researcher, Fondazione Emanuela Zancan, Padova (ITA) and President, International Association of Outcome-Based Evaluation and Research in Family and Children’s Services (IAOBER); Mark Courtney, Professor, School of Social Service Administration, University of Chicago (USA); Laurah Currey, Chief Operating Officer, Pressley Ridge, Pittsburgh, PA (USA) and President, Association for Children’s Residential Centers, (USA); Daniel. L. Daly, Executive Vice President and Director of Youth Care, Father Flanagan’s Boys’ Home, Boys Town, NE (USA); Robbie Gilligan, Professor of Social Work and Social Policy, Trinity College Dublin IRE), Hans Grietens, Professor, Centre for Special Needs Education & Youth Care, University of Groningen (NLD) and President, European Scientific Association on Residential and Family Care for Children and Adolescents (EUSARF); Annemiek T. Harder, Assistant professor, Department of Special Needs Education and Youth Care, University of Groningen (NLD); Martha J. Holden, Senior Extension Associate with the Bronfenbrenner Center for Translational Research and the Principal Investigator and Director of the Residential Child Care Project at Cornell University, Ithaca, NY (USA); Sigrid James, Professor, Department of Social Work & Social Ecology, School of Behavioral Health, Loma Linda University, CA (USA); Andrew Kendrick, Professor of Residential Child Care, School of Social Work and Social Policy at the University of Strathclyde (GBR) and Consultant at the Centre of Excellence for Looked After Children in Scotland (CELCIS) and the Centre for Youth and Criminal Justice (CYCJ) (UK); Erik J. Knorth, Professor, Department of Special Needs Education and Youth Care, University of Groningen (NLD); Mette Lausten, Senior Researcher at SFI - The Danish National Centre for Social Research, Copenhagen (DNK), John S. Lyons, Senior Policy Fellow at Chapin Hall, University of Chicago, IL (USA); Eduardo Martin, Lecturer at the Department of Developmental and Educational Psychology, University of La Laguna, Tenerife (ESP); Samantha McDermid, Research Fellow, Centre for Child and Family Research, Loughborough University (GBR); Patricia McNamara, Senior Fellow (Honorary), Department of Social Work, University of Melbourne (AUS); Laura Palareti, Assistant Professor in Social Psychology, Department of Education Studies, University of Bologna (ITA); Susan Ramsey, Parent and Former Children’s Mental Health Advocate, The Walker School, Needham, MA (USA); Kari M. Sisson, Executive Director, Association of Children’s Residential Centers (USA); Richard W. Small, Walker Executive Director Emeritus, The Walker School, Needham, MA (USA); June Thoburn, Emeritus Professor of Social Work, University of East Anglia (GBR); Ronald Thompson, Senior Director, Boys Town National Research Institute for Child and Family Studies, Boys Town, NE (USA); Anat Zeira, Professor, School of Social Work and Social Welfare, Hebrew University of Jerusalem, and Head of Research and Evaluation at the Haruv Institute (ISR). Our work group wishes to thank CFRC staffer Laura Dale at Loughborough for extraordinary efforts in producing this statement in record time and for her care and assistance with all phases of our Summit activity. Whittaker, James K; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erik; Lausten, Mette; Lyons, John; Martin, Eduardo; Mcdermid, Samantha; Mcnamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat Whittaker, James K; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erik; Lausten, Mette; Lyons, John; Martin, Eduardo; Mcdermid, Samantha; Mcnamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat

Two experiments were run in which the structure of the Interpersonal Check List (ICL) was studied. Both studies demonstrated that the ICL comprised a circular ordering of traits at several levels of intensity. This structure, defined by Guttman as a radex, incorporates the social desirability of trait ratings in a simple model.

BACKGROUND AND OBJECTIVE:The American Academy of Pediatrics called for action for improved screening of mental health issues in the emergency department (ED). We developed the rapid screening tool home, education, activities/peers, drugs/alcohol, suicidality, emotions/behavior, discharge resources (HEADS-ED), which is a modification of “HEADS,” a mnemonic widely used to obtain a psychosocial history in adolescents. The reliability and validity of the tool and its potential for use as a screening measure are presented.METHODS:ED patients presenting with mental health concerns from March 1 to May 30, 2011 were included. Crisis intervention workers completed the HEADS-ED and the Child and Adolescent Needs and Strengths-Mental Health tool (CANS MH) and patients completed the Children’s Depression Inventory (CDI). Interrater reliability was assessed by using a second HEADS-ED rater for 20% of the sample.RESULTS:A total of 313 patients were included, mean age was 14.3 (SD 2.63), and there were 182 females (58.1%). Interrater reliability was 0.785 (P < .001). Correlations were computed for each HEADS-ED category and items from the CANS MH and the CDI. Correlations ranged from r = 0.17, P < .05 to r = 0.89, P < .000. The HEADS-ED also predicted psychiatric consult and admission to inpatient psychiatry (sensitivity of 82% and a specificity of 87%; area under the receiver operator characteristic curve of 0.82, P < .01).CONCLUSIONS:The results provide evidence to support the psychometric properties of the HEADS-ED. The study shows promising results for use in ED decision-making for pediatric patients with mental health concerns.

The present study is designed to identify which types of trauma experiences interact with later development of normal and abnormal sexual behavior in children and adolescents. More specifically, our goal is to determine which types of trauma exposure are related to issues of sexuality, sexually reactive behavior, sexually aggressive behavior, and the combination of both sexually reactive and sexually aggressive behavior. A sample of 5,976 children ages 5 to 18 who were wards of the State of Illinois were studied. All children were assessed with the Child and Adolescent Needs and Strengths (CANS) at entry into care. These data were used to understand the relationship between prior trauma experiences and the expression of problematic sexual behavior. Child sexual abuse was the most common form of maltreatment found in children and adolescents with problematic sexual behaviors. However, other types of trauma experiences, especially exposure to violence, were also related. Sexual abuse and multiple trauma exp...

The relationship between grade retention and adolescent depression in the course of school dropout is poorly understood. Improving knowledge of the mechanisms involving these variables would shed light on at-risk youth development. This study examines whether depression in adolescence moderates the relationship between grade retention and school dropout in a high-risk sample. Seventh-grade students (n = 453) from two low-SES secondary schools in Montreal (Quebec, Canada) were followed from 2000 to 2006. Self-reported lifetime and seventh-grade depression were measured with the Inventory to Diagnose Depression. Primary school grade retention, and secondary school dropout status was obtained through the Ministry of Education of Quebec registries. Sixteen percent of participants reported lifetime depression, and 13% reported depression in seventh-grade. Nearly one third (32%) of the sample dropped out of school. Logistic regression models were used to estimate moderation effects predicting school dropout six years later. Findings indicated that students with grade retention were 5.54 times more likely to drop out of school. Depression in seventh grade increased by 2.75 times the likelihood of school dropout. The probability of dropping out for adolescents combining both grade retention and seventh-grade depression was 7.26 times higher than it was for those reporting grade retention only. The moderating effect of depression was similar for boys and girls. Depression is a significant vulnerability factor of low educational attainment aggravating the risk associated with grade retention. Experiencing depression at the beginning of secondary school can interfere with school perseverance particularly for students who experienced early academic failure.

Several epidemiological studies have reported that large numbers of children and adolescents suffer from diagnosable psychiatric conditions, however most of them do not receive treatment. The schools are a key setting where youth with mental health problems are identified and linked to treatment. In this study we examine the demographic and clinical characteristics of youth referred to a school-based mental health intervention, the youth characteristics associated with continued participation in the intervention at 6-month follow up, and the youth characteristics that are associated with intensity of service use at 6-month follow up. The data were analyzed using descriptive frequencies, Chi-square tests and t tests, and bivariate and multivariable Poisson regressions. Demographic and clinical characteristics were not found to be significantly associated with discontinuing services before 6-months; however, several youth who discontinued services before 6-months had clinical characteristics suggesting a possible need for services. Youth demographic (sex, race) and clinical (diagnosis, suicidal ideation, alcohol/drug use, psychiatric medication use, and physical health) characteristics were significantly associated with intensity of service use in the multivariable analysis. This study underscores the importance of monitoring program participation, after the referral has been made and services have been accessed, to assure that youth participate in treatment long enough to obtain clinical benefits.

The effectiveness of mental health care services is severely limited when young people run away from residential treatment. This study describes the development of a decision support model for predicting discharge due to running away on the basis of individual characteristics. Subjects include 667 wards of a large Midwestern state between the ages of 7 and 20 who were placed in residential treatment and discharged during 2007. A model combining eight predictors—namely School Attendance, History of Running/Runaway Ideation, and linear as well as quadratic terms for Age, Substance Abuse and Delinquency—demonstrated good internal validity and moderate predictive power for discharge due to elopement. Results of this study can support mental health care workers in identifying potential recipients of interventions that reduce the likelihood of premature exits from residential care among young people.

Abstract: The concept of incorporating multiple perspectives in measurement is a foundation of program evaluation in human service enterprises, but can place significant challenges on the feasibility and interpretation of projects. This article reviews triangulation methodologies and proposes a new approach to triangulation. It argues that, in order to address some of the burdens associated with triangulation in human services program evaluation, the simple notion of pre-measurement triangulation through the use of communimetric measurement theory may present an effective option. An example of such a tool is provided, along with a discussion regarding the utility and limitations of these strategies.

ACADEMIC EMERGENCY MEDICINE 2010; 17:848–858 © 2010 by the Society for Academic Emergency Medicine Abstract Objectives: A decision support tool may guide emergency clinicians in recognizing assessment, analgesic and overall management, and health service delivery needs for patients with sickle cell disease (SCD) in the emergency department (ED). We aimed to identify data and process elements important in making decisions regarding evaluation and management of adult patients in the ED with painful episodes of SCD. Methods: Qualitative methods using a series of focus groups and grounded theory were used. Eligible participants included adult clients with SCD and emergency physicians and nurses with a minimum of 1 year of experience providing care to patients with SCD in the ED. Patients were recruited in conjunction with annual SCD meetings, and providers included clinicians who were and were not affiliated with sickle cell centers. Groups were conducted until saturation was reached and included a total of two patient groups, three physician groups, and two nurse groups. Focus groups were held in New York, Durham, Chicago, New Orleans, and Denver. Clinician participants were asked the following three questions to guide the discussion: 1) what information would be important to know about patients with SCD in the ED setting to effectively care for them and help you identify patient analgesic, treatment, and referral needs? 2) What treatment decisions would you make with this information? and 3) What characteristics would a decision support tool need to have to make it meaningful and useful? Client participants were asked the same questions with rewording to reflect what they believed providers should know to provide the best care and what they should do with the information. All focus groups were audiotaped and transcribed. The constant comparative method was used to analyze the data. Two coders independently coded participant responses and identified focal themes based on the key questions. An investigator and assistant independently reviewed the transcripts and met until the final coding structure was determined. Results: Forty-seven individuals participated (14 persons with SCD, 16 physicians, and 17 nurses) in a total of seven different groups. Two major themes emerged: acute management and health care utilization. Major subthemes included the following: physiologic findings, diagnostics, assessment and treatment of acute painful episodes, and disposition. The most common minor subthemes that emerged included past medical history, presence of a medical home (physician or clinic), individualized analgesic treatment plan for treatment of painful episodes, history of present illness, medical home follow-up available, patient-reported analgesic treatment that works, and availability of analgesic prescription at discharge. Additional important elements in treatment of acute pain episodes included the use of a standard analgesic protocol, need for fluids and nonpharmacologic interventions, and the assessment of typicality of pain presentation. The patients’ interpretation of the need for hospital admission also ranked high. Conclusions: Participants identified several areas that are important in the assessment, management, and disposition decisions that may help guide best practices for SCD patients in the ED setting.