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This paper describes a 10-session behavioral intervention introducing female-initiated methods of human immunodeficiency virus (HIV) prevention to reduce vulnerability to HIV infection for women with severe mental illness. In a pilot test of the intervention, 35 women were randomly placed in the experimental intervention group or an HIV education control. Subjective norms, intentions to use, perceived efficacy, and attitudes toward the male condom, female condom, and a microbicide were assessed at baseline, postintervention, and 6-week follow-up. The participants in the treatment group reported a significantly more positive attitude toward the use of female condoms (t = −2.12, P

Adolescents whose parents are living with AIDS face daily challenges and stressors related to the stage of their parent's illness and the adjustment following their parent's death. An intensive, cognitive-behavioral intervention is described that addresses coping at each phase of adjustment. Targeting long-term social, behavioral, and mental health outcomes of the adolescent, parents living with AIDS and their adolescent children participate in both joint and independent workshops in order to enhance their affective and behavioral skills to cope with the parent's illness. The intervention is delivered in three modules of 8 to 16 sessions each. In Module 1, parents are helped to recognize their emotional response to their own diagnosis; make decisions about illness status disclosure; and establish positive daily routines in their household. Module 2 focuses on parenting, custody and estate planning. Adolescents join their parents for the last 8 sessions, addressing their reactions to parental illness and daily routines. After the parent dies, adolescents and their new custodial parents address issues of bereavement and adjustment in Module 3. The efficacy of this intervention is currently being evaluated.

Adolescent suicide attempts are increasing. However, therapy is often not received following the attempt, and psychiatric symptoms, psychosocial problems and suicidality usually persist. Interventions in the emergency room are proposed as a means of enhancing treatment adherence among adolescent suicide attempters and their families. Pediatric physicians, psychiatric residents, psychiatric child fellows, nurses, security personnel and admitting clerks, can be retrained to increase treatment adherence by improving interactions between emergency-room staff and the families, changing the families' expectations regarding therapy and establishing a contract for short-term treatment with the attempters and their families.

As the number of youths infected with HIV rises, secondary prevention programmes are needed to help youths living with HIV meet three goals: (1) increase self-care behaviours, medical adherence and health-related interactions; (2) reduce transmission acts; and (3) enhance their quality of life. This article describes an intervention programme for youths living with HIV, delivered over 30 sessions, in three modules. Based on modifications of the social action model, perceptions, attitudes and skills to enhance affective awareness and positive behavioural routines are identified as prerequisites for meeting each of the targeted outcomes. In each module, youths engage in small-group activities over 8-12 sessions with other infected peers to modify their behavioural patterns. Module 1 focuses on choosing one's social identity with respect to a seropositive status, implementing new daily routines to stay healthy, coping with receiving high quality medical care and keeping safe from reinfection. Module 2 aims to reduce substance use and unprotected sexual acts. Module 3 focuses on using sensory awareness as a strategy for enhancing the quality of life. A variety of delivery strategies are discussed for secondary interventions.

Objective This article describes a brief, standardized, cognitive-behavioral treatment program for adolescent suicide attempters and their families. Method Successful Negotiation Acting Positively (SNAP) treatment consists of a series of structured activities that create a positive family atmosphere, teach problem-solving skills, shift the family's understanding of their problems to troublesome situations rather than difficult individuals, and build confidence in the treatment professional, thereby reducing conditions associated with future attempts. Results SNAP treatment has been systematically administered to more than 100 suicidal adolescents and their families as part of an ongoing treatment study. Although these results are not yet available, our initial experience suggests that SNAP treatment can be delivered in a reliable fashion and is well accepted by both patients and therapists. Conclusions Although suicidality in youth constitutes a major public health problem, few therapeutic interventions have been developed specifically for suicidal adolescents. SNAP treatment addresses a number of issues critical to successful interventions with this population, including their historically poor treatment compliance, the need for family involvement in treatment, and an emphasis on coping and problem-solving strategies. Moreover, the brief, structured format of SNAP treatment is consistent with the growing trend toward standardized, empirically tested, and cost-efficient interventions.

Background The spread of human immunodeficiency virus infection to impaired groups has intensified the challenge for its prevention; control of the epidemic now requires behavioral change among persons with limited ability to sustain attention and learn. In this randomized clinical trial, we tested an intervention to reduce sexual risk behaviors among homeless men with severe mental illness. Methods Men were recruited from a psychiatric program in a homeless shelter. Of 116 eligible men, 97 (83.6%) participated. Most were African American and had a chronic psychotic disorder and a comorbid substance use disorder. Participants were assigned to a 15-session experimental group intervention or to a 2-session control intervention and observed for 18 months. The 59 participants sexually active before the trial were the main target of the intervention. Sexual risk behavior was the primary outcome. Results Among the 59 sexually active men, follow-up data were obtained on 59 (100%) for the initial 6-month follow-up and on 56 (95%) for the remainder of the 18-month follow-up. The mean score on a sexual risk index for the experimental group was 3 times lower than for the control group (1.0 vs 3.1; P =.01) during the initial 6-month follow-up and 2 times lower during the remainder of the 18-month follow-up. Conclusions This intervention successfully reduced sexual risk behaviors of homeless men with mental illness. The effect diminished over 18 months but did not disappear. Similar approaches may be effective in other impaired high-risk groups.

Negotiations with outside agencies have become a new endeavor for many mental health managers. However, a significant barrier to managers learning the theory and skills of bargaining arises in the values possessed by mental health professionals, which encourage them to see negotiations as exploitative and consequently unethical and unhealthy. This paper reports on an effort to study and work through these value issues within the negotiating context.

The State of Colorado has introduced performance contracting into its relationships with community mental health centers. The nature of the contract and its implementation are described. Particular emphasis is placed on the implications of the contract for program evaluation. Essentially, the contract provides a clearer focus and richer data while complicating the evaluator's tasks.

The Colorado Division of Mental Health implemented a quality assurance program in all of its mental health facilities. The system was designed to help managers know how they were doing on operational issues. The program was simple, low cost, and easy to implement. All levels of management found it a useful tool in getting control of important processes.

A comprehensive study of both the feasibility and the desirability of operating a state mental health system without a state hospital, except for a small forensic facility, was carried out in Vermont. Feasibility was examined in terms of client needs, service system capabilities, financing, human resource requirements, legal and rights protection issues, and political considerations. The study team concluded that developing comprehensive regional community support and rehabilitation services to replace the state hospital for all public mental health clients except forensic patients was both feasible and desirable since it would result in better services at a roughly equivalent cost to the state. The team also developed recommendations for optimizing the success of regionalization.