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Background: Psychological services are increasingly provided within a context in which third party payers impose limits on the number of sessions available to the client and therapist. Considerable research has addressed the effect of time limits on therapeutic outcomes, while effects on therapeutic process have received less attention. This article reports on research that assessed the perceived impact of externally determined time limits on therapeutic process from the perspective of practicing psychologists. Methods: This study used a concurrent triangulation mixed-methods design. Study 1 was a repeated measures questionnaire that was both qualitative and quantitative in nature, and Study 2 utilised qualitative semi-structured interviews. Twenty-seven Australian psychologists treating clients within externally imposed time limits were interviewed, and 85 completed a questionnaire to obtain their perspective on the impact of time limits on the therapeutic process. Results: Therapeutic approach was impacted by time limits, including choice of therapeutic modality, shifts in problem definition and approach, and increased directiveness, prompting concern about a focus on symptom removal over facilitating maintenance of treatment gains. Conclusions: This research contributes to an understanding of how temporal constraints influence treatment, and managed care funding policies may need to be considered in the light of this understanding.

Young offenders internationally have a higher incidence of mental health problems compared with adolescents in the general population. Mental health issues, particularly comorbid presentations, affect the response to and outcome of rehabilitation and hence recidivism of offending. Most information on the mental health of young offenders has derived from studies of incarcerated young offenders, potentially a more disturbed sample of young people than the majority of young offenders who are placed on community orders. Our study investigated young offenders serving community-based orders (n = 800); the sample comprised almost 29% of the available population. Approximately 40% had at least one score in the severe range for psychopathology as assessed by the Adolescent Psychopathology Scale-Short Form (APS-SF) and 17% reported at least one comorbid condition. Twenty-six percent (26%) and 19% of young offenders scored in the severe range on the Substance Abuse and Conduct Disorder scales respectively and 8% scored in the severe range on both scales. Eighteen percent (18.5%; n = 145) had scores in the severe range for Substance Abuse and at least one other subscale (excluding Conduct Disorder); 10.8% (n = 85) had scores in the severe range for Conduct Disorder and at least one other subscale (excluding Substance Abuse); and 2.7% (n = 21) had scores in the severe range for at least two scales excluding Substance Abuse and Conduct Disorder. Young women reported between two and four times greater internalizing pathology and self-harm behavior than young men; however, young women were more characterized by externalizing disorders and anger than they were by depression or anxiety. Notwithstanding, high/very high levels of psychological distress were reported (25%) on the Kessler-10. This sample also reported high rates of child abuse and neglect on the Childhood Trauma Questionnaire and these experiences were associated with more severe externalizing pathology. In the year prior to the study, 8% of the sample had considered suicide, 5% had attempted suicide and 16% had considered or attempted other forms of self-harm. Although as a group the sample revealed high levels of behavioral disturbance and high needs for treatment, a low number reported engagement in any treatment. Recommendations for early intervention as well as tertiary treatment programs are considered. (Contains 8 tables and 2 figures.)

Young offenders internationally have a higher incidence of mental health problems compared with adolescents in the general population. Mental health issues, particularly comorbid presentations, affect the response to and outcome of rehabilitation and hence recidivism of offending. Most information on the mental health of young offenders has derived from studies of incarcerated young offenders, potentially a more disturbed sample of young people than the majority of young offenders who are placed on community orders. Our study investigated young offenders serving community-based orders (n = 800); the sample comprised almost 29% of the available population. Approximately 40% had at least one score in the severe range for psychopathology as assessed by the Adolescent Psychopathology Scale-Short Form (APS-SF) and 17% reported at least one comorbid condition. Twenty-six percent (26%) and 19% of young offenders scored in the severe range on the Substance Abuse and Conduct Disorder scales respectively and 8% scored in the severe range on both scales. Eighteen percent (18.5%; n = 145) had scores in the severe range for Substance Abuse and at least one other subscale (excluding Conduct Disorder); 10.8% (n = 85) had scores in the severe range for Conduct Disorder and at least one other subscale (excluding Substance Abuse); and 2.7% (n = 21) had scores in the severe range for at least two scales excluding Substance Abuse and Conduct Disorder. Young women reported between two and four times greater internalizing pathology and self-harm behavior than young men; however, young women were more characterized by externalizing disorders and anger than they were by depression or anxiety. Notwithstanding, high/very high levels of psychological distress were reported (25%) on the Kessler-10. This sample also reported high rates of child abuse and neglect on the Childhood Trauma Questionnaire and these experiences were associated with more severe externalizing pathology. In the year prior to the study, 8% of the sample had considered suicide, 5% had attempted suicide and 16% had considered or attempted other forms of self-harm. Although as a group the sample revealed high levels of behavioral disturbance and high needs for treatment, a low number reported engagement in any treatment. Recommendations for early intervention as well as tertiary treatment programs are considered. doi: 10.1300/J076v45n01_10 KEYWORDS Juvenile offenders, mental health, child abuse, conduct disorders and substance misuse, rehabilitation

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.jsat.2006.05.017 Byline: Christopher John Lennings, Dianna T. Kenny, Paul Nelson Keywords: Young offenders; Substance abuse; Treatment access Abstract: Both international and Australian studies reveal very low rates of treatment utilization for substance abuse among young offenders despite very high problematic rates of substance abuse among this group. The current study reports on substance use patterns of a representative sample of 712 young offenders serving community orders with the New South Wales Department of Juvenile Justice (Australia) and their history of and attitudes toward treatment. Most (87%) young offenders had used marijuana, and 47% had used amphetamines in the last 12 months. One third of the sample reported problematic use of alcohol (being drunk at least weekly, on average). Forty-three percent reported that they engaged in crime to maintain their substance use. On the substance abuse scale of the Adolescent Psychopathology Scale -- Short Form, 36.4% of the sample fell into the moderate to severe problem range. Despite such problems, treatment motivation was poor: 10% reported willingness to access treatment for their drug problems. Eighteen percent reported accessing some form of treatment in the past; the most common form of help seeking was approaching their family (12%). Self-reported access to other drug treatments was even lower, with the more intensive treatments revealing low rates of treatment completion. Despite almost 40% of the sample revealing significant substance abuse problems, referral for treatment was also low, with only 18% of the sample being offered an appointment with juvenile justice drug and alcohol workers. This study reveals the gap between awareness of problematic drug use and treatment-seeking behavior, and has implications for improving outreach to young offenders with substance abuse problems. Author Affiliation: Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW 2141, Australia Article History: Received 6 January 2006; Revised 22 May 2006; Accepted 24 May 2006 Article Note: (footnote) The views expressed in this article are not necessarily those of the New South Wales Department of Juvenile Justice and the New South Wales Justice Health.

Discusses arguments in favor of the establishment of a specific youth detoxification center in Brisbane, Queensland. Age appropriation program; Means for drug types by decision to leave; Gaps in service provision.