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Objective: To characterize neurocognitive response to cerebrospinal fluid (CSF) diversion during a multiday external lumbar drainage (ELD) trial in patients with suspected normal pressure hydrocephalus (NPH). Methods: Inpatients (N = 70) undergoing an ELD trial as part of NPH evaluation participated. Cognition and balance were assessed using standardized measures before and after a three-day ELD trial. Cognitive change pre- to post-ELD trial was assessed in relation to change in balance, baseline neuroimaging findings, NPH symptoms, demographics, and other disease-relevant clinical parameters. Results: Multiday ELD resulted in significant cognitive improvement (particularly on measures of memory and language). This improvement was independent of demographics, test-retest interval, number of medical and psychiatric comorbidities, NPH symptom duration, estimated premorbid intelligence, baseline level of cognitive impairment, cerebrovascular disease burden, degree of ventriculomegaly, or other NPH-related morphological brain alterations. Balance scores evidenced a greater magnitude of improvement than cognitive scores and were weakly, but positively correlated with cognitive change scores. Conclusions: Findings suggest that cognitive improvement associated with a multiday ELD trial can be sufficiently captured with bedside neurocognitive testing. These findings support the utility of neuropsychological consultation, along with balance assessment, in informing clinical decision-making regarding responsiveness to temporary CSF diversion for patients undergoing elective NPH evaluation. Implications for the understanding of neuroanatomical and cognitive underpinnings of NPH are discussed. [ABSTRACT FROM AUTHOR]

Mental health and traumatic stress symptoms are prevalent in juvenile offenders, yet research on diversion programs rarely examine these important outcomes. Program duration and the role of protective factors are also understudied in this literature. This study examined the impact of program duration and youth protective factors on mental health and traumatic stress symptoms of 713 youth participating in an Illinois diversion program. Overall, the more time youth spent in the diversion program, the more improvement they demonstrated in mental health and trauma symptoms. Both program duration and number of youth strengths at program entry were significantly associated with improvement in mental health and traumatic stress symptoms. Findings highlight the importance of program duration and suggest that youth protective factors should be identified early on and targeted to maximize the impact of juvenile justice diversion programs on mental health and trauma symptoms. [ABSTRACT FROM AUTHOR]

Effective service interventions greatly enhance the well-being of foster youth. A study of 262 foster youth examined one such intervention, therapeutic mentoring. Results showed that mentored youth improved significantly in the areas of family and social functioning, school behavior, and recreational activities, as well as in the reduction of expressed symptoms of traumatic stress. Study results suggest that therapeutic mentoring shows promise for enhancing treatment interventions. (Contains 4 tables.)

A variety of factors are putting great pressure on residential treatment centers to justify their role in the child serving system through evidence of impact on the lives of children, youth, and families. The present study describes the role of residential treatment from an outcomes perspective in a midsized state over the course of a 5 year period in which efforts were made to reduce out-of-community placements. The process of developing a system of care approach to the child serving system while matching children and youth needs to the use of residential treatment resulted in placing more challenging children and youth in these placements over time. The results of this process included an improvement in within-episode outcomes from residential treatment. A hinge analysis in which children and youth were described using a common assessment before and after placement in a range of treatments/programs helped explicate the role of residential treatment serving the most challenging children and youth successfully. The necessary length of stay for residential treatment from a clinical perspective depends greatly on the continued treatment options post-discharge. (Contains 12 figures and 3 tables.)

Objectives: To determine whether traumatic experiences of children entering the child welfare system have an impact on their risk behaviors and whether these behaviors are moderated by children's strengths. Method: The Illinois Department of Children and Family Services administered the Child and Adolescent Needs and Strengths (CANS) measure to 8,131 children as they entered custody and analyzed Traumatic Experiences, Risk Behaviors and Strengths using polytomous logistic regression models. Results: Children entering child welfare have suffered multiple traumatic experiences. There is a strong linear relationship between the number of these experiences and the level of the children's high risk behaviors. However, there is an interactive effect between traumatic experiences and children's strengths on the risk behaviors, with strengths having a greater moderating effect as the number of traumatic experiences increases. Conclusions: Children entering the child welfare system present with complicated histories that include multiple traumatic experiences and multiple high risk behaviors. However, the more strengths these children have developed, the less likely they are to engage in high-risk behaviors. This resilience has major implications for both prevention and treatment. (Contains 2 figures and 6 tables.)

We examined the differential outcomes in residential treatment for youths with conduct disorder (CD)--with special attention paid to interactions with age and gender--in a sample of children and adolescents in 50 residential treatment centers and group homes across Illinois. Multi-disciplinary teams rated youths ages 6-20 (N = 457) on measures of mental health and other factors within 30 days of admission, about 7 months after admission, and at discharge. While both groups initially responded similarly to treatment, the CD group performed better relative to the non-CD group over the full course of treatment, showing healthier relative change on five outcomes variables and more significant improvement. Age range moderated the relationship between CD group membership and change in work/school performance. There were significant between groups differences within the youngest age group (6-11 years) in which the CD group worsened relative to the non-CD group.

Evidence suggests that a moderate amount of variance in patient outcomes is attributable to therapist differences. However, explained variance estimates vary widely, perhaps because some therapists achieve greater success with certain kinds of patients. This study assessed the amount of variance in across-session change in symptom intensity scores explained by therapist differences in a large naturalistic data set (1,198 patients and 60 therapists, who each treated 10-77 of the patients). Results indicated that approximately 8% of the total variance and approximately 17% of the variance in rates of patient improvement could be attributed to the therapists. Cross-validation and extreme group analyses validated the existence of these therapist effects.

At least three circumstances have converged to focus attention on the outcomes associated with residential treatment. First, the reduction in lengths of stay in the psychiatric hospital has resulted in residential treatment becoming the most expensive service on a per episode basis. Second, the increasing emphasis on the identification and use of evidence-based practices has potentiated interest in determining the effectiveness of program types. Finally, the use of managed care and care management strategies in support of systems of care philosophies has put pressure on reducing residential treatment expenditures to fund the expansion of community-based services. Prior research suggests that outcomes of residential treatment may not be uniform across settings. The present study used hierarchical linear modeling techniques to compare the outcome trajectories of residential treatment facilities across the state of Illinois. It was demonstrated that substantial provider profile differences in outcome do exist between facilities. (Contains 3 tables.)

Examined the relationship between perceived maternal control and depression for 11 urban adolescent girls seeking psychological services at an outpatient clinic. No relation between control and depression was found for Caucasian and Latina girls, but high control was linked to less depression among African American girls. Findings highlight the importance of ethnicity in studies of child rearing and depression. (SLD)

A strategy to separate patients into homogeneous subgroups to generate maximum expected treatment response profiles, which can be used to predict and track the progress of patients in different treatment modalities, is presented. A discussion of the various ways in which this procedure can be used in outpatient centers to learn more about patients, predict treatment response and improve clinical practice are presented.

To make use of psychotherapy research in practice, therapists need real-time access to valid clinically relevant information about patients. The dose-effect and phase models of psychotherapy provide a theoretical background for empirically based psychotherapy management by describing the systematic nature of progress in therapy and guiding the selection of outcome criteria. Given this theoretical background, it is possible to derive appropriate models for monitoring cases in ongoing therapies (patient profiling) and identifying therapists' relative strengths and weaknesses (severity-adjusted provider profiling). These applied methods may be used to inform decision making in ongoing psychotherapies and to support supervision and clinical training. Keywords: patient-focused research; growth curve models; outcomes management; expected treatment response; therapist performance

Adaptive treatment planning is a dynamic process that is dependent on valid, systematic assessments. The dosage and phase models provide theoretical bases for the development of such 'patient-focused' information. Given an underlying mathematical regularity to the recovery process, growth modeling techniques can be used to determine an expected treatment response for every patient. By mapping the patient's actual status against such an expected change trajectory, it is possible to address the most clinically relevant question, 'Is this treatment working?'

Treatment-focused research is concerned with the establishment of the comparative efficacy and effectiveness of clinical interventions, aggregated over groups of patients. The authors introduce and illustrate a new paradigm - patient-focused research - that is concerned with the monitoring of an individual's progress over the course of treatment and the feedback of this information to the practitioner, supervisor, or case manager.

A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has been made in an earlier phase. Thus, clinical improvement in subjective well-being potentiates symptomatic improvement, and clinical reduction in symptomatic distress potentiates life-functioning improvement. A large sample of psychotherapy patients provided self-reports of subjective well-being, symptomatic distress, and life functioning before beginning individual psychotherapy and after Sessions 2, 4, and 17 when possible. Changes in well-being, symptomatic distress, and life functioning means over this period were consistent with the 3-phase model. Measures of patient status on these 3 variables were converted into dichotomous improvement-nonimprovement scores between intake and each of Sessions 2, 4, and 17. An analysis of 2 X 2 cross-classification tables generated from these dichotomous measures suggested that improvement in well-being precedes and is a probabilistically necessary condition for reduction in symptomatic distress and that symptomatic improvement precedes and is a probabilistically necessary condition for improvement in life functioning.