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The extent that participant characteristics are associated with outcome disparities for behavioral treatments generally, and adolescent drug abuse treatments in particular, is arguably one of the most important, albeit difficult to answer questions in the psychotherapy field (Blake, Amaro, Schwartz, & Flinchbaugh, 2001). Limited knowledge about gender and ethnicity as moderators remains ubiquitous in treatment research. Sparse representation of minority individuals in RCTs and paucity of subgroup analyses based on ethnicity has been well-documented. For example, a recent review of NIMH-funded randomized clinical trials, revealed that only 10% and 5% reported moderation analyses for gender and ethnicity, respectively (Mak, Law, Alvidrez, & Perez-Stable, 2007). A major impediment for conducting these subgroup analyses has been small to moderate sample sizes (80% had less than 200 participants). Ethnic and gender subgroup sizes have been seldom more than 40 with consequently little power to test moderation (Mak et al., 2007). From this perspective, the state of the literature stands at odds with a growing emphasis on disseminating evidence-based treatments (EBT) on a wide-scale, and researchers have argued that results from existing RCTs cannot be generalized to individuals from ethnic minority backgrounds (Hall, 2001; Sue, Zane, Hall, & Berger, 2009). Correspondingly, there has been recognition that treatment needs, processes, and outcomes might differ across gender (American Psychological Association, 2007; Blake et al., 2001). Although girls and women generally have been adequately represented in RCTs, few researchers have investigated potential gender differences in treatment effects (Mak et al., 2007).

This study examined the trajectories of maltreatment severity and substantiation over a 24-month period among children (N = 82,396) with repeated maltreatment reports. Findings revealed 2 different longitudinal patterns. The first pattern, Elevated Severity, showed a higher level of maltreatment during the initial incident and increased maltreatment severity during subsequent incidents, but the substantiation rates for this class decreased over time. The second pattern, Lowered Severity, showed a much lower level of severity, but the likelihood of substantiation increased over time. The Elevated Severity class was composed of children with an elevated risk profile because of both individual and contextual risk factors including older age, female gender, caregivers’ substance use problems, and a higher number of previous maltreatment reports. Implications of the findings are discussed.

This randomized clinical trial (RCT) compared Multidimensional Family Therapy (MDFT) with residential treatment (RT) for adolescents with co-occurring substance use and mental health disorders on substance use, delinquency, and mental health symptoms. Using an intent-to-treat design, 113 adolescents who had been referred for residential treatment were randomly assigned to either RT or MDFT in the home/community. The sample was primarily male (75%) and Hispanic (68%) with an average age of 15.4 years. Seventy-one percent of youth had at least one previous residential treatment placement. Participants were assessed at baseline and at 2, 4, 12 and 18 months post-baseline. During the early phase of treatment (baseline to 2 months), youth in both treatments showed significant reductions in substance use [substance use problems (d = 1.10), frequency of use (d = 1.36)], delinquent behaviors (d = 0.18) and externalizing symptoms (d = 0.77), and youth receiving MDFT reported significantly greater reductions in internalizing symptoms than youth receiving RT (d = 0.42). In phase 2, from 2 to 18 months after baseline, youth in MDFT maintained their early treatment decreases in substance use problems (d = 0.51), frequency of use (d = 0.24), and delinquent behaviors (d = 0.42) more effectively than youth in RT. During this period, there were no significant treatment differences in maintenance of gains for externalizing and internalizing symptoms. Results suggest that Multidimensional Family Therapy is a promising alternative to residential treatment for youth with substance use and co-occurring disorders. The results, if supported through replication, are important because they challenge the prevailing assumption that adolescents who meet criteria for residential treatment cannot be adequately managed in a non-residential setting.

Baseline data collected in two brief intervention projects (BI-Court and Truancy Project) were used to assess similarities and differences in subgroups of at-risk youth. Classifications of these subgroups were based on their psychosocial characteristics (e.g., substance use). Multi-group latent class analysis (LCA) identified two BI-Court subgroups of youth, and three Truant subgroups. These classes can be viewed as differing along two dimensions, substance use involvement and emotional/behavioral issues. Equality tests of means across the latent classes for BI-Court and Truancy Project youths found significant differences that were consistent with their problem group classification. These findings highlight the importance of quality assessments and allocating appropriate services based on problem profiles of at-risk youth.

This study examined childhood abuse, problem behavior, drinking style, and dating violence (DV). Our goal was to assess whether (a) alcohol use-related beliefs and behaviors ("drinking style") would be associated with DV perpetration and victimization, (b) drinking style would mediate the relationship between childhood abuse and DV, and (c) the drinking style-DV relationship would be attributable to propensity for problem behavior.Cross-sectional survey data were collected from 456 youth ages 14-21 years who were patients in an urban emergency department. Participants were eligible if they were unmarried and reported past-month alcohol use and dating in the past year. By design, the sample was 50% female. Data were analyzed using structural equation modeling.For both males and females, past-year DV was associated with a more risky drinking style, characterized by more frequent alcohol use, alcohol-aggression expectancies, drinking to cope, and beliefs that alcohol is disinhibiting and that being drunk provides a "time-out" from behavioral expectations. Drinking style mediated the childhood victimization-DV relationship for males and females. However, when propensity for problem behavior was included in the model, the effect of drinking style on DV was no longer significant. Substantial path differences for males and females were observed.The current study examined adolescent drinking style as a potential mediator between childhood victimization and DV. Drinking style was associated with DV for males and females and mediated the relationship between childhood victimization and DV. The relationship between drinking style and DV appeared to reflect adolescents' propensity for problem behavior. Variations in males' and females' pathways to DV were observed. The implications of these findings are discussed.

How are characteristics of communities associated with the implementation of the principles of systems of care (SOC)? This study uses multilevel modeling with a stratified random sample (N = 225) of US counties to explore community-level predictors of the implementation factors of the System of Care Implementation Survey. A model composed of community-level social indicators fits well with 5 of 14 factors identified as relevant for effective SOCs. As hypothesized, community disadvantage was negatively and residential stability positively associated with the implementation of SOC principles. Designation as a mental health professional shortage area was positively related to some implementation scores, as was the percentage of minority residents, while rurality was not significantly associated with any of the factors. Given the limitations of the study, the results should be interpreted with caution, but suggest that further research is merited to clarify these relationships that could inform efforts directed at promoting SOCs.

A major impediment to obtaining national information on systems of care implementation has been the lack of a psychometrically sound large-scale survey instrument. The present study provided information on the factorial and concurrent validity of the Systems of Care Implementation Survey scales. Multilevel confirmatory factor analysis and multilevel regression analysis were used to test these indicators of internal and external validity. Two hundred twenty-five counties were randomly selected and stratified by population size and poverty level. Nine hundred ten informants responded to the survey questionnaire, M = 4.04 informants per county (SD = 3.17). Results indicated that all models had at least adequate fit to the data, with nine of the 14 factor models having excellent fit. Overall, 11 of the 14 factors had some indication that receiving federal funding to create systems of care was associated with higher scores on the factors. Implications for future research were discussed.

The results of a survey to measure the implementation of the systems of care (SOC) approach in a nationally representative sample of counties are presented. The results from 910 informants within 225 counties reveal a moderate level of implementation of SOC factors, with the level of poverty and population size influencing implementation. Furthermore, mental health informants generally tended to rate the implementation of systems of care greater than administrators associated with the school system, other family serving agency personnel or family members. Family members and school personnel tended to rate the implementation lowest, while staff from the other child serving agencies tended to rate the implementation closer to mental health administrators. A quarter of the counties (26%) surveyed rated themselves as having adequate levels of implementation on 11 or more of the 14 factors, while 75% rated themselves as having adequate levels of implementation on six or more of the 14 factors measured. Implications for federal policies regarding systems of care implementation are discussed.

In previous research using timeline follow-back methods to closely monitor drinking and related variables over the first year of college (9 months), we showed that drinking varied considerably over time in accord with academic requirements and holidays. In a new community sample (N = 576) of emerging adults (18- and 19-year-olds who reported having begun drinking prior to recruitment), we used similar methods to compare drinking patterns in college and noncollege individuals over a full calendar year (including summer). To reduce the extreme distortion in computations of average drinking over restricted time spans (i.e., 1 week) that arise because large numbers of even regular drinkers may not consume any alcohol, we analyzed data using recently developed two-part latent growth curve modeling. This modeling distinguished consumption levels from numbers of individuals drinking in a given period. Results showed that drinking levels and patterns generally did not differ between college and noncollege drinkers, and that both groups responded similarly to even those contexts that may have seemed unique to one (i.e., spring break). We also showed that computation of drinking amounts without accounting for "zero drinkers" could seriously distort estimates of mean drinking on some occasions; for example, mean consumption in the total sample appeared to increase on Thanksgiving, whereas actual average consumption for those who were drinking diminished.

Objective: We used growth mixture modeling to examine heterogeneity in treatment response in a secondary analysis of 2 randomized controlled trials testing multidimensional family therapy (MDFT), an established evidence-based therapy for adolescent drug abuse and delinquency. Method: The first study compared 2 evidence-based adolescent substance abuse treatments: individually focused cognitive–behavioral therapy and MDFT in a sample of 224 urban, low-income, ethnic minority youths (average age 15 years, 81% male, 72% African American). The second compared a cross-systems version of MDFT (MDFT—detention to community) with enhanced services as usual for 154 youths, also primarily urban and ethnic minority (average age 15 years, 83% male, 61% African American, 22% Latino), who were incarcerated in detention facilities. Results: In both studies, the analyses supported the distinctiveness of 2 classes of substance use severity, characterized primarily by adolescents with higher and lower initial severity; the higher severity class also had greater psychiatric comorbidity. In each study, the 2 treatments showed similar effects in the classes with lower severity/frequency of substance use and fewer comorbid diagnoses. Further, in both studies, MDFT was more effective for the classes with greater overall substance use severity and frequency and more comorbid diagnoses. Conclusions: Results indicate that for youths with more severe drug use and greater psychiatric comorbidity, MDFT produced superior treatment outcomes.

This paper provides an introduction to a recently developed conceptual framework— the dimensional–categorical spectrum—for utilizing general factor mixture models to explore the latent structures of psychological constructs. This framework offers advantages over traditional latent variable models that usually employ either continuous latent factors or categorical latent class variables to characterize the latent structure and require an a priori assumption about the underlying nature of the construct as either purely dimension or purely categorical. The modeling process is discussed in detail and then illustrated with data on the delinquency items of Achenbach’s child behavior checklist from a sample of children in the National Adolescent and Child Treatment Study.

Although there is literature supporting the effectiveness of tertiary behavioral supports, the majority of the studies have been conducted with single-subject designs. The Prevent—Teach—Reinforce (PTR) model is a standardized model of a school-based tertiary intervention. This study reports initial results from a randomized controlled trial to compare whether the PTR model, as implemented by typical school personnel, is more effective than interventions typically used (i.e., services as usual). To date, 245 students in Grades K-8 have been enrolled in the study, and preliminary results show that students who received the PTR intervention had significantly higher social skills and academic engaged time and significantly lower problem behavior when compared with students who received services as usual. Teachers gave high social validity ratings to the intervention. Implications for widescale school adoption are discussed.

This article examines the impact of sociodemographic characteristics and psychosocial factors on the probability and frequency of marijuana use and, for youths initiating use, on their frequency of use over four time points. The sample consists of 278 justice-involved youths completing at least one of three follow-up interviews as part of a National Institute on Drug Abuse (NIDA)–funded study. A two-part growth model was estimated to examine the probability of engaging in marijuana use and change in marijuana frequency of use over time. In addition, covariates for intervention status, gender, age, race, ethnicity, psychological functioning, alcohol use, and self-reported delinquency were included as baseline predictors in the model. The results of our two-part latent growth model reveal (1) a latent tendency to engage in marijuana use and a conditional, continuing decision on frequency of marijuana use, and (2) different patterns of relationships among age, psychosocial variables, and the probability and ...

This study examined characteristics and profiles of 196 child maltreatment perpetrators in Florida, including 126 who committed fatal assaults during 1999–2002. Results of logistic regression suggest that being a biologically unrelated caregiver is the strongest predictor of fatal child maltreatment. Latent Class Analysis (LCA) was used to classify perpetrators, and three classes were identified: Biological Mothers with Health Problems, Male Perpetrators with Domestic Violence History, and Multiple-Problem Perpetrators. Results of LCA showed that compared to Biological Mothers with Health Problems, Multiple-Problem Perpetrators were seven times more likely and Male Perpetrators with Domestic Violence History were 12 times more likely to commit a fatal assault. Implications of the findings are discussed.

Research has established the dangers of early onset substance use for young adolescents and its links to a host of developmental problems. Because critical developmental detours can begin or be exacerbated during early adolescence, specialized interventions that target known risk and protective factors in this period are needed. This controlled trial (n = 83) provided an experimental test comparing multidimensional family therapy (MDFT) and a peer group intervention with young teens. Participants were clinically referred, were of low income, and were mostly ethnic minority adolescents (average age = 13.73 years). Treatments were manual guided, lasted 4 months, and were delivered by community agency therapists. Adolescents and parents were assessed at intake, at 6-weeks post-intake, at discharge, and at 6 and 12 months following treatment intake. Latent growth curve modeling analyses demonstrated the superior effectiveness of MDFT over the 12-month follow-up in reducing substance use (effect size: substance use frequency, d = 0.77; substance use problems, d = 0.74), delinquency (d = 0.31), and internalized distress (d = 0.54), and in reducing risk in family, peer, and school domains (d = 0.27, 0.67, and 0.35, respectively) among young adolescents.

Aim To examine the efficacy of two adolescent drug abuse treatments: individual cognitive behavioral therapy (CBT) andmultidimensionalfamilytherapy(MDFT).Design A2(treatmentcondition)x4(time)repeated-measuresintent- to-treat randomized design. Data were gathered at baseline, termination, 6 and 12 months post-termination. Analyses used latent growth curve modeling. Setting Community-based drug abuse clinic in the northeastern United States. Participants A total of 224 youth, primarily male (81%), African American (72%), from low-income single-parent homes (58%) with an average age of 15 years were recruited into the study. All youth were drug users, with 75% meeting DSM-IV criteria for cannabis dependence and 13% meeting criteria for abuse. Measurements Five outcomes were measured: (i) substance use problem severity; (ii) 30-day frequency of cannabis use; (iii) 30-day frequency of alcohol use; (iv) 30-day frequency of other drug use; and (v) 30-day abstinence. Findings Both treatments produced significant decreases in cannabis consumption and slightly significant reductions in alcohol use, but there were no treatment differences in reducing frequency of cannabis and alcohol use. Significant treatment effects were found favoring MDFT on substance use problem severity, other drug use and minimal use (zero or one occasion of use) of all substances, and these effects continued to 12 months following treatment termination. Conclusion Both interven- tions are promising treatments. Consistent with previous controlled trials, MDFT is distinguished by the sustainability of treatment effects.

To describe the development and assess the validity and reliability of the Collaborative Care for Attention-Deficit Disorders Scale (CCADDS), a measure of collaborative care processes for children with attention-deficit/hyperactivity disorder who attend primary care practices.Collaborative care was conceptualized as a multidimensional construct. The 41-item CCADDS was developed from an existing instrument, review of the literature, focus groups, and an expert panel. The CCADDS was field tested in a national mail survey of 600 stratified and randomly selected practicing general pediatricians. Psychometric analysis included assessments of factor structure, construct validity, and internal consistency.The overall response rate was 51%. Most respondents were male (56%), 46 years old or older (59%), and white (69%). Common factor analysis identified 3 subscales: beliefs, collaborative activities, and connectedness. Internal consistency reliability (coefficient alpha) for the overall scale was .91, and subscale scores ranged from .80 to .89. The CCADDS correlated with a validated measure of provider psychosocial orientation (r = -.36, P.001) and with self-reported frequency of mental health referrals or consultations (r = -.24 to -.42, P.001). CCADDS scores were similar among physicians by race/ethnicity, gender, age group, and practice location.Scores on the CCADDS were reliable for measuring collaborative care processes in this sample of primary care clinicians who provide treatment for children with attention-deficit/hyperactivity disorder. Evidence for validity of scores was limited. Future research is needed to confirm its psychometric properties and factor structure and provide guidance on score interpretation.

For the study reported here, the authors used growth mixture modeling to analyze changes in alcohol and marijuana use and the use of drug and alcohol treatment services for a sample of 180 adolescents with serious emotional disturbance (ages 12—14 years at the beginning of the 7-year longitudinal study).Three latent classes of substance users were identified, two of which exhibited significant linear increases in substance use. As expected, adolescents who were heavily involved in substance use at the beginning of the study and who significantly increased their substance use were the most likely to receive the greatest number of alcohol and drug services. Adolescents who had low levels of substance use at the beginning of the study but whose substance use increased significantly during the study received fewer services. The fact that the initially low substance-use class eventually ended up resembling the high substance-use class at the end of the 7-year study underscores the importance of collecting longitudinal data on substance use and employing the rate of change in substance use as an indicator of the need for treatment. Advantages of growth mixture and parallel processing modeling for studying changes in substance use and services are discussed.

Binge drinking is associated with clinically significant individual-level and public health consequences. The topography of binge drinking may influence the emergence of consequences, but studies of topography require a higher level of temporal resolution than is typically available in epidemiological research. To address topography across the 5 "peak" years of binge drinking (18 to 23 years), we assessed daily binge drinking via successive 90-day timeline follow-back interviews of 645 young adults (resulting in almost 700,000 data points). RESULTS showed a weekend "pulse" of binge drinking that remained consistent across the entire 5 year span, with occasional holiday-based perturbations. Two-part latent growth curve modeling applied to this dataset showed that the often-observed decrease in drinking associated with "maturing out" was due more to decreased participation in binge drinking occasions, rather than to amounts consumed when drinking (intensity). Similarly, the number of binge drinkers varied by day of the week, but the intensity of binge drinking, for those drinking, varied little by day of the week. This approach also showed distinctive predictors for participation and intensity; baseline expectancies and sociability accounted for individual differences in participation, whereas impulsivity-sensation seeking predicted intensity. Individual patterns of binge drinking participation and intensity also predicted drinking consequences over the 5 years of the study. Given these results, binge drinking patterns may serve as a useful phenotype for future research on pathological drinking. (PsycINFO Database Record Language: en

The objective of this article is to examine the effectiveness of 2 theoretically different treatments delivered in juvenile drug court—family therapy represented by multidimensional family therapy (MDFT) and group-based treatment represented by adolescent group therapy (AGT)—on offending and substance use. Intent-to-treat sample included 112 youth enrolled in juvenile drug court (primarily male [88%], and Hispanic [59%] or African American [35%]), average age 16.1 years, randomly assigned to either family therapy (n 55) or group therapy (n 57). Participants were assessed at baseline and 6, 12, 18 and 24 months following baseline. During the drug court phase, youth in both treatments showed significant reduction in delinquency (average d .51), externalizing symptoms (average d 2.32), rearrests (average d 1.22), and substance use (average d 4.42). During the 24-month follow-up, family therapy evidenced greater maintenance of treatment gains than group-based treatment for externalizing symptoms (d 0.39), commission of serious crimes (d .38), and felony arrests (d .96). There was no significant difference between the treatments with respect to substance use or misdemeanor arrests. The results suggest that family therapy enhances juvenile drug court outcomes beyond what can be achieved with a nonfamily based treatment, especially with respect to what is arguably the primary objective of juvenile drug courts: reducing criminal behavior and rearrests. More research is needed on the effectiveness of juvenile drug courts generally and on whether treatment type and family involvement influence outcomes. Trial Registry Name: Clinical Trials.gov, Identified NCT01668303.

The purpose of this study was to assess the effects of a GEAR UP intervention with at-risk high school students at a large urban high school in Florida. The goals of the GEAR UP program were to improve academic performance, decrease behavior-related problems, and reduce truancy and absenteeism. The study design consisted of a three-group comparison of the 447 students in GEAR UP: the No Participation Group, the Low Participation Group, and the High Participation Group. Participation levels were calculated for each category of activity (academic, behavior-related, and social), and propensity scoring was used to match the groups on sociodemographic characteristics and other differentiating variables. Results indicated that race (i.e., African American) and sex (i.e., female) are associated with high participation in program activities. Also, students who spent a substantial amount of time on academic activities improved their GPAs over a semester, and students who took advantage of behavior-related services and participated in social activities significantly reduced disciplinary referrals (p < .05). Suggestions for program refinement resulting from the study are discussed.

Based on previous work (Darkes, Greenbaum, & Goldman, 1998), we evaluated the effects of item order and ambiguity on factor structure using items from the Disinhibition subscale of the Sensation Seeking Scales Form V (Zuckerman, 1979). Participants completed the items with order of item-group (alcohol, sex, ambiguous) presentation manipulated between respondents. The factor structure varied as a function of item-group order. In addition, factor covariances varied across the 3 item orders as a function of item-group order. Apparently, ambiguous items were interpreted differently (as related either to alcohol use or to sexual behavior) depending on the content of items that preceded them. Results suggest that item order and ambiguity are important considerations in assessment.

Two measures of psychopathic features in youths, the self-report version of the Antisocial Process Screening Device (APSD) and the Youth Psychopathic traits Inventory (YPI) were administered to 165 youths in a juvenile diversion program. For both measures, internal consistency was poor for the scales that assess the affective domain of psychopathic features; otherwise, internal consistency was excellent for the YPI and generally superior to that of the APSD. However, the published three-factor models for both measures did not replicate when examined using confirmatory factor analysis. Both measures obtained the expected correlations with measures of a variety of criminal justice (e.g., age of delinquency onset, past year delinquent behavior) and psychological constructs (e.g., internalizing and externalizing behavior), providing evidence of construct validity for both measures. The YPI appears to be the better measure for exploring the construct of psychopathy in adolescents. Recommendations are made concerning revisions to the APSD.

F. K. Del Boca, J. Darkes, P. E. Greenbaum, and M. S. Goldman (2004) examined temporal variations in drinking during the freshmen college year and the relationship of several risk factors to these variations. Here, using the same data, the authors investigate whether a single growth curve adequately characterizes the variability in individual drinking trajectories. Latent growth mixture modeling identified 5 drinking trajectory classes: light-stable, light-stable plus high holiday, medium-increasing, highdecreasing, and heavy-stable. In multivariate predictor analyses, gender (i.e., more women) and lower alcohol expectancies distinguished the light-stable class from other trajectories; only expectancies differentiated the high-decreasing from the heavy-stable and medium-increasing classes. These findings allow for improved identification of individuals at risk for developing problematic trajectories and for development of interventions tailored to specific drinker classes.

Comorbidity of substance abuse disorders (SUD) and psychiatric disorders is one of the most important areas of investigation in contemporary drug abuse treatment research. This study examined the impact of psychiatric comorbidity on the treatment of 182 adolescent drug abusers in a randomized clinical trial comparing family and individual cognitive-behavioral therapy. Three distinct groups of adolescent substance abusers were compared: (1) Exclusive Substance Abusers (SUD only); (2) Externalizers (SUD + externalizing disorder); and (3) Mixed Substance Abusers (SUD + externalizing and internalizing disorder). The purpose of this study was to determine whether adolescents in these comorbid groups differed in clinical presentation and treatment response. More severe comorbidity was associated with greater family dysfunction and being female and younger at intake. An examination of substance use trajectories over time indicated that the Mixed group initially responded to treatment but returned to intake levels of substance use by 1 year post-discharge.

Alcohol expectancies' mediation of many known antecedents' influence on drinking has been well established, but most models have omitted theoretically relevant mediational pathways through both common (overlapping) and unique (nonshared) expectancy variance. The authors of this study evaluated expectancy mediation using a hierarchical expectancy model that specified both common and unique expectancy factors. The hierarchical model mediated a significantly (p

Aims: To demonstrate an integrative methodology to explore psychological constructs, we used multiple methods in the examination of alcohol expectancies—a psychological construct that is generally measured using survey methodology. We then used the methodology in order to assess the relationship of alcohol expectancy dimensions to drinking-related outcomes. Design: We developed alcohol expectancy models using a cognitive paradigm designed to maximize cognitive activation of expectancies, in order to delineate dimensions of alcohol expectancies. Next, using multidimensional scaling (MDS), we defined heuristic models representing domains for arousing, sedating, positive, and negative alcohol expectancies. We then assessed these models in a separate sample using confirmatory factor analysis (CFA) and covariance structure modeling. Setting: The research was conducted at a large public university in the southeastern US. Participants: A total of 927 male and female college students ranging in age from 17 to 35 years participated. Measurements: Measures included the Alcohol Expectancy Inventory, the Quantity Frequency Index (QFI), and the Drinking Styles Questionnaire. Findings: Single indicator models representing expectancies for arousing and positive effects of alcohol did not differ significantly in the prediction of drinking, and both accounted for significantly more variance in self-reported drinking than expectancies for sedating and negative effects of alcohol consumption. Expectations for the sedating effects of alcohol accounted for significantly more variance than those for negative effects. Expectations for sedating effects added unique variance in the prediction of drinking when all predictors were simultaneously modeled. Conclusions: The multiple methods integrated here can be used in the development and testing of alcohol expectancy models. This integrative methodology warrants further development and validation.

In this article, we describe the outcomes associated with a 3-year research demonstration project. It is the second of a two-part article concerned with this research conducted in the Bronx, New York, to examine the efficacy of three models of intensive in-home services—Home-Based Crisis Intervention (HBCI), Enhanced Home-Based Crisis Intervention (HBCI+),and Crisis Case Management—as alternatives to hospitalization for children experiencing a psychiatric crisis. In Part I (Evans, Boothroyd, & Armstrong, 1997), we described the features of the three program models, the research design, data collection measures, and the presenting characteristics of the children and families. In Part 2, we describe the success of maintaining children at home (82%) and the increases in family adaptability, children's self-concept, and parental self-efficacy both at discharge and at 6 months postdischarge. Enrollees in two of the models (HBCI and HBCI+) experienced a significant increase in family cohesion,although this was not maintained at 6 months postdischarge. While enrollees in the enhanced program showed significant increase in social support at discharge, all enrollees experienced this at 6 months postdischarge.

Rates of change in strength- and deficit-based behaviors in relation to community adjustment were examined for 292 participants in the 7-year longitudinal National Adolescent and Child Treatment Study (NACTS; Greenbaum et al., 1996) as they transitioned from adolescence to the adult world. Scores from 6 domains including education, employment, residence, social support network, self-reported and caretaker-reported satisfaction were combined to form the Index of Community Adjustment (ICA). Participants with higher social-adaptive behavior upon entry into NACTS and whose social-adaptive behavior improved over time attained higher ICA scores.These results underscore the need to provide comprehensive and integrated services that promote development of social-adaptive skills associated with successful transition to adulthood for individuals with emotional challenges.

The purpose of this study was to identify risk factors for early pregnancy and outcomes of early parenthood among girls with serious emotional disturbance (SED). Longitudinal data were collected during a 7-year period from 190 female adolescents with SED, ages 9 to 18 at the beginning of the study, and their families. Of the sample, 39% had their first pregnancy by age 18.The results of univariate analyses indicated that among examined risk factors (a) being African American, (b) low family income, (c) dropping out of school, (d) conduct disorder, and (e) substance use disorder were significantly ( ps < .05) associated with early pregnancy. However, according to multivariate analysis, only dropping out of school was a significant predictor of early pregnancy.The study also examined outcomes of early parenthood for girls with SED. Girls who had children were more likely ( ps < .05) to live in poverty, receive public assistance, and live independently. Dropout status also was examined as an outcome variable,and was a significantly more ( p < .05) frequent consequence for girls who had children.

Little is known about the characteristics of children and youth presenting at emergency settings in psychiatric crisis, and virtually nothing is known about their outcomes. The purpose of this study is to describe the clinical profiles of 238 children presenting at two psychiatric emergency settings and enrolled in a randomized controlled trial of three intensive in-home interventions. A second purpose is to examine child mental health outcomes, based on clinical profile and to suggest the utility of using a clinical-profiles approach.

Evaluating the fidelity of service practices to system-of-care principles (SOC) represents a challenge in the human service field. The inadequate infusion of SOC principles into direct services could limit the usefulness of this approach. In this study we compare practice-level variables between well-developed SOC and traditional service systems and test the hypothesis that the adoption of SOC principles at the organizational level was associated with greater implementation of SOC at the practice level. Sites implementing SOC for at least 5 years are compared to sites providing mental health services using a traditional service delivery model. The study administered the SOC Practice Review (SOCPR) protocol. The SOCPR represents a case study approach that employs interviews and document reviews to arrive at ratings of SOC principles.This methodology proved to be an effective tool in interpreting the meaning of child and family experiences that emerged from the SOC.The findings were generally significant and support the hypothesis. Overall, SOC sites scored significantly higher (p < .05) than non-SOC sites in the child-centered and family-focused, community-based, and cultural competence domains.The implication is that SOC principles can be tested at the level of practice.

The present study examined the extent to which the use of multiple measures of pedophilic interest improved on the diagnostic accuracy of any single measure. Seventy-two child molesters completed a self-report card-sort measure of sexual interest, as well as direct monitoring of penile response (penile plethysmograph-PPG) when presented with erotic slides or audio material. The reliability of all measures was high (alpha .91-.96). All three measures of pedophilic interest (i.e., card sort, PPG slides, PPG audio) significantly differentiated boy-object (n = 20) and girl-object child molesters (n = 52). The card-sort measure showed the greatest classification accuracy and was the only measure to significantly improve accuracy, once the other two modalities were considered. Consideration of all three modalities provided classification accuracy (91.7%) greater than any single measure.

Hierarchical confirmatory factor analysis was used to evaluate the 2-factor 2nd-order structure of T. M. Achenbach's (1991) Child Behavior Checklist in a sample of 577 children who had been identified as having serious emotional disturbance. An alternative 1-factor 2nd-order model also was tested. Results supported T. M. Achenbach's model in which the broadband Internalizing factor was represented by the narrowband Withdrawn, Somatic, and Anxious/Depressed syndromes, and the broadband Externalizing factor was represented by the narrowband Delinquent and Aggressive syndromes. Consistent with T.M. Achenbach's model, the remaining narrowband syndromes (i.e., Social, Thought, Attention) loaded equally on both broadband factors and should not be included in scoring either Internalizing or Externalizing. Fit of the 1-factor model also was good and only slightly poorer than the 2-factor model. Therefore, an overall score would be appropriate as a measure of global problem behavior.

Disinhibition has been theorized to increase risk for alcohol abuse. Because a major index of disinhibition, the Disinhibition subscale of the Sensation Seeking Scales (DIS; M. Zuckerman, 1979, 1987), includes items that explicitly ask about alcohol use (see M. Zuckerman, 1994), the nature and extent of predictor-criterion contamination merits investigation. Using structural equation modeling, this study examined the factor structure and predictive validity of the DIS with drinking in 1,217 college students. A 3-factor model best fit the DIS, and prediction of drinking by these factors varied based on their intrinsic levels of alcohol relatedness. Hence, the relationship between alcohol abuse risk and the DIS may require reconsideration. The factor structure of the DIS also varied between light and heavy drinkers; the clinical and psychometric implications of this finding are discussed.

Although a hierarchical structure of alcohol expectancies has been hypothesized, until recently confirmatory methods for testing such a model have been unavailable. Using concurrent data from 446 young adults entering college for the first time, this study applied new hierarchical models for confirmatory factor analysis to the Alcohol Expectancy Questionnaire. Then, using prospective drinking data from 428 participants, it evaluated the contribution of both common (higher order) and unique (first-order) expectancy variance to the prediction of alcohol use 1 year later. Results supported the hierarchical structure of alcohol expectancies and indicated that associated common and unique variance reliably predicted alcohol use. One uniqueness (social-physical pleasure) outpredicted the common variance. The theoretical (process) implications of these findings are discussed.

Confirmatory factor analysis (CFA) was used to evaluate the factor structure of T. M. Achenbach's eight cross-informant syndrome scales of the Child Behavior Checklist (CBCIJ4-18) using data generated on a sample of 631 youngsters, ages 8 to 18 years (M= 14.02, SD = 2.39), who had been classified as having serious emotional disturbances. Results of the CFA (overall fit, pattern of factor loadings, and syndrome correlations) support Achenbach's eight-correlated-factor model and provide additional evidence of the construct validity of the scores obtained from the CBCV/4-18.

Latent class analysis was conducted on the psychosocial problems experienced by truant youths. Data were obtained from baseline interviews completed on 131 youths and their parents/guardians involved in a NIDA-funded, Brief Intervention Project. Results identified two classes of youths: Class 1(n=9) - youths with low levels of delinquency, mental health and substance abuse issues; and Class 2(n=37) - youths with high levels of these problems. Comparison of these two classes on their urine analysis test results and parent/guardian reports of traumatic events found significant (p

The specific purpose of the study was to compile descriptive data on children with serious emotional disturbance (SED), including (a) demographic and family characteristics, (b) level of psychological and adaptive functioning, (c) services received, and (d) outcomes or how the children fared over time. The sample consisted of 812 children, ages 8 to 18 years (M = 13.89 years, SD = 2.35), who had been identified as having SED and were being served by either mental health (46%) or public school (54%) systems in accordance with P.L. 94–142. Data were collected annually during a 7-year period. Results indicated that, at entry into the study, the children already had serious problems in many domains and the problems remained serious for these children at the end of the study.

Using a 3-wave longitudinal design, adolescents were studied over a 2-year period during which many first began to drink. Covariance structure modeling showed that teens' expectancy for social facilitation from alcohol and their drinking experience influenced each other in a reciprocal, positive feedback fashion: the greater the expectancy endorsement, the higher subsequent drinking levels, and the higher the drinking levels, the greater the subsequent expectancy endorsement. This model fit the data quite well; comparison models, in which expectancy (or drinking) had no independent influence on future drinking (or expectancy), showed significantly poorer fit than the present model. Initial nondrinkers' social expectancy predicted individual differences in the rate of drinking increase over the 2 years. Results bolster the hypothesis that expectancy actively influences drinking and point to the importance of expectancy-based intervention efforts. Language: en

Reflective of interest in mental health and substance abuse issues among youths involved with the justice system, we performed a latent class analysis on baseline information collected on 100 youths involved in two diversion programs. Results identified two groups of youths: Group 1: a majority of the youths, who had high levels of delinquency, mental health, and substance abuse issues; and Group 2: youths with low levels of these problems. Comparison of these two groups on a variety of psychosocial measures and parent/guardian reports found differences between them that were consistent with their problem group classification. Follow-up analysis confirmed problem behavior that was consistent with the youths’ latent class placement. Implications of the findings for research and practice are presented.

The children’s system of care framework has been extensively implemented in the U.S. Since its inception in 1993, the Comprehensive Community Mental Health Services for Children and Their Families Program has invested in excess of $1 billion supporting the development of systems of care in 164 grantee sites across the country. Despite these efforts to implement children’s systems of care nationally, little is known about the extent to which the principles and values actually have been put into practice outside of the funded grantee sites. This paper describes the development of the Systems of Care Implementation Survey, a measure designed specifically for the first ever study assessing the level of implementation of factors contributing to effective children’s systems of care in a nationally representative sample of counties throughout the U.S.

The results of a survey to measure the implementation of the systems of care (SOC) approach in a nationally representative sample of counties are presented. The results from 910 informants within 225 counties reveal a moderate level of implementation of SOC factors, with the level of poverty and population size influencing implementation. Furthermore, mental health informants generally tended to rate the implementation of systems of care greater than administrators associated with the school system, other family serving agency personnel or family members. Family members and school personnel tended to rate the implementation lowest, while staff from the other child serving agencies tended to rate the implementation closer to mental health administrators. A quarter of the counties (26%) surveyed rated themselves as having adequate levels of implementation on 11 or more of the 14 factors, while 75% rated themselves as having adequate levels of implementation on six or more of the 14 factors measured. Implications for federal policies regarding systems of care implementation are discussed.

Multilevel confirmatory factor analysis was used to evaluate the factor structure underlying the 12-item, three-factor Interagency Collaboration Activities Scale (ICAS) at the informant level and at the agency level. Results from 378 professionals (104 administrators, 201 service providers, and 73 case managers) from 32 children’s mental health service agencies supported a correlated three-factor model at each level and indicated that the item loadings were not significantly ( p > .05) different across levels. Reliability estimates of the three factors (Financial and Physical Resource Activities, Program Development and Evaluation Activities, and Collaborative Policy Activities) at the agency level were .81, .60, and .72, respectively, whereas these estimates were .79, .82, and .85 at the individual level. These multilevel results provide support for the construct validity of the scores from the ICAS. When the ICAS was examined in relation to Level 1 and Level 2 covariates, results showed that participants’ characteristics (i.e., age, job role, gender, educational level, and number of months employed) and agency characteristics (i.e., state location and number of employees) were not significantly ( p > .05) related to levels of interagency collaboration.

Data were collected on arrested youths processed at a centralized intake facility, including youths released back to the community and those placed in secure detention. This paper reports the results of a test of a structural model involving newly arrested male and female youths' sexually transmitted diseases (STD) test results, urine analysis results for recent cocaine and marijuana use, and self-reported engaging in risky sexual behavior. The across gender, multiple group model involved: (1) a confirmatory factor analysis of these variables, reflecting a latent variable labeled Risk, (2) a regression of Risk on the youths' age, and (3) an examination of the covariance between Risk and the youths' race and seriousness of arrest charge. Results indicate the youths' STD status, drug use, and reported risky sexual behavior are interrelated phenomena, similarly experienced across gender. Age was the only correlate of Risk status that demonstrated a significant gender group difference. The youths' race and seriousness of arrest charges did not significantly affect Risk, regardless of gender. Research and policy implications of the findings are discussed.

The National Adolescent and Child Treatment Study (NACTS) was designed to study children identified and served by the public mental health and special education systems as seriously emotionally disturbed. Children (N=812) and their parents (N=740) participated in the first wave of data collection in this longitudinal study. Subjects lived in six states, with approximately half in psychiatric residential treatment centers and the other half in public school special education programs. A multi-method, multi-source methodology was employed. The sample is characterized by externalizing problems, poor adaptive functioning, and substantial academic deficits. Residential children were more likely to have blended families, were more likely to have previously received residential treatment, and had higher rates of conduct disorder, anxiety, and attention deficit disorder, as measured by the Diagnostic Interview Schedule for Children. The two groups did not differ on intelligence, age of onset, or rates of schizophrenia or depression. The data suggest the presence of greater at-risk factors in the residential group and different paths of entry into special education and residential treatment programs.

Incarcerated adolescents are among the most vulnerable groups for STD infection, and substance abuse is prevalent in over half of this population. Substance abuse and HIV/STD-associated risk behaviors are closely linked among juvenile justice-involved youth, but it is unclear whether common antecedents explain these different problems. The current study examined predictors of HIV/STD risk level and substance use disorders, and investigated whether family variables added unique predictive variance for these problems among incarcerated youth. The sample included 154 substance-involved youth ages 13 to 17 recruited in detention facilities in Miami and Tampa, FL and was primarily male (82%) and African-American (58%). Using a comprehensive assessment strategy with data obtained from youth report, parent report, and laboratory confirmed STD testing, the results show that delinquency is a consistent predictor of both HIV/STD risk level and substance use disorders, and also that substance use directly predicts HIV/STD risk level among incarcerated adolescents. Consistent with previous research, family conflict is an important predictor of substance use disorders even after controlling for other factors. The results suggest the need for integrated family-based interventions addressing delinquency, substance abuse, and HIV/STD-associated risk factors with juvenile justice-involved adolescents.

Among 547 adolescents with serious emotional disturbances, ages 12 to 18, this study assessed (1) prevalence of DSM-III substance use disorders (i.e., alcohol and marijuana abuse/dependence), and (2) comorbidity with DSM-III Axis I disorders. Factors of age, sex, state location, and type of treatment program also were examined. Data were analyzed by logistic regression. Significant factors (p less than 0.05) associated with severe alcohol or marijuana abuse/dependency diagnosis included (1) residential mental health treatment program, 2.37 Odds Ratio (OR); (2) conduct disorder diagnosis, 2.18 OR; (3) depression diagnosis, 1.75 OR; (4) states, 1.43 OR; (5) age, 1.29 OR; and (6) a depression x facility interaction, 1.91 OR.

Objective To determine availability of and test whether on-site mental health providers (MHP) is associated with greater odds of reported mental health consultation and referral among primary care pediatricians. Methods Pediatricians were identified from the American Medical Association's 2004 physician directory and stratified by region. Six hundred were randomly selected to receive a mail survey. The main independent variable was on-site MHP. The dependent variable was reported frequency (4-point rating) of mental health consultation and referral. Estimates were weighted to account for survey design and nonresponse. Results Overall response rate was 51%. The majority of respondents were male (56%), age ≥46 years old (59%), white (68%), and practicing in suburban locations (52%). Approximately half reported consultation with (44%) or referral to (51%) MHP always or often, but a few (17%) reported on-site MHP. After adjustment for demographic and practice characteristics, pediatricians with on-site MHP were more likely to consult (odds ratio [OR] 6.58, 95% confidence interval [95% CI] 3.55- 12.18) or refer (OR 4.25, 95% CI 2.19–8.22) than those without on-site MHP. Among those without on-site MHP, pediatricians with greater practice burden were less likely to consult (OR 0.69, 95% CI 0.48–0.99) or refer (OR 0.75, 95% CI 0.54–1.04) than those with lesser burden. Conclusions Most pediatricians in the United States experienced practice-related burdens that limit mental health collaboration, but those with co-located services reported a greater likelihood of consultation and referral. Policy changes that encourage co-location of mental health services and limit practice burden may facilitate mental health consultation and referral.