The Boys Town Residential Treatment Center: Treatment Implementation and Preliminary Outcomes

A well specified residential treatment model is described, and preliminary outcome data are presented. The Boys Town Psycho-Educational Model (PEM) empowers direct care staff to be important treatment agents by training them to use systematic teaching techniques. Data obtained on youth served at the center since its inception in December 1995 indicate that the youth have had multiple prior placements and serious psychiatric disorders. The model sustains an active and positive treatment environment as documented by high levels of focused treatment occurring during the youth’s stays. To date, 94% of the youth have departed to placements that were equal to, or less restrictive than, their placements at admission to the program. Of those who had Children’s Global Assessment Scale ratings both at admission and at discharge, 84% (n=21) of the youth had better functioning at discharge.     

Engagement,Residential Treatment Staff Cognitive and Behavioral Disputations,and Youths’ Problem-Solving

In this study, the researchers examined the relationship between residential treatment staff members’ use of cognitive and behavioral disputations and problem-solving skills just prior to discharge for 59 youths with emotional and behavioral disorders. The researchers also assessed the direct and indirect effects of engagement in treatment on problem-solving. Measures completed by youths, childcare staff, and clinicians were used in order to comprehensively understand these relationships. The relationship between cognitive and behavioral disputations, as measured by both youth and staff, and problem-solving skills was not significant. Youth and staff reports of engagement in treatment related directly to youth report, but not staff report, of cognitive and behavioral disputations. Youth report of engagement was the only predictor of problem-solving just prior to discharge. Implications for engaging youth in treatment are discussed.     

A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders

The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter‐relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta‐analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small‐to‐moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.     

Adapting “The Staff Attitudes to Nutritional Nursing Care scale” to geriatric nursing care

Objective  A positive attitude is assumed to be important in nursing staff’s help and support of elderly people during meals. As there is no specific tool for measuring staff’s attitudes regarding important issues within eating and nutrition, the SANN (Staff Attitudes to Nutritional Nursing Care) scale was developed. The scale was developed and tested in nursing staff working at resident homes, and the number of items was reduced from 63 to 19 with five underlying factors. The aim of this study was to describe how the SANN scale was adapted and tested in nursing staff working in different types of elderly care. Design: The raw 63-item version went through minor changes, and one unclear worded item was excluded. The changed raw 62-item version was answered by 188 nursing staff working at six hospital care clinics and 64 staff working at one resident home. Results  The analysis reduced the 62 items to 18, and the adapted scale was named the SANN-G scale, G standing for “geriatric care”. A rotated factor analysis gave a five-factor solution, explaining 54% of the variance. The scale achieved good internal reliability, with a Cronbach’s alpha of 0.83. Fourteen items fulfilled inclusion criteria in both the SANN and the SANN-G scales. Conclusion  The SANN-G scale is practicable for use in staff working in different types of elderly care. It can be used to explore existing attitudes and identify areas with a low degree of prevailing positive attitudes as well as to evaluate whether and how attitudes change after nutritional education and intervention.     

Teachers’ Interactions and their Collaborative Reflection Processes during Peer Meetings

Teachers’ reflections are often narrowly focused on technical questions (‘how to’) and less on the underlying moral, political and emotional aspects of their functioning. However, for a better understanding of teaching practice it is important to uncover beliefs and values that usually remain implicit. Meeting with others is considered crucial for enhancing the quality of teachers’ reflections. However, little is known about how any beneficial effects of such meetings are brought about. We explored the relationship between medical teachers’ interactions and collaborative reflection processes during peer meetings. Five experienced teachers and a teacher trainer participated in the study. Three peer meetings were videotaped and transcribed. Teachers’ interactions and collaborative reflective processes were analysed. The interactions promoted reflection not only on technical questions but also on moral, political, and emotional issues. ‘Guiding/directing’, ‘proposing an alternative’ and ‘exploring an alternative’ appeared to be the principal interactions. The results may be useful for teachers and trainers who are considering organising and/or improving peer meetings.     

Sexual Pleasure and Condom Use

The purpose of the present study was to determine whether sexually-experienced individuals’ pleasure ratings for protected and unprotected vaginal intercourse would be related to actual condom use. College participants (80 women and 35 men, M age = 22.29 years) who reported engaging in vaginal intercourse in the past 3 months completed a questionnaire that assessed their perceptions of the pleasurability of unprotected and condom-protected vaginal intercourse and their own sexual behaviors. Both women and men rated unprotected vaginal intercourse as more pleasurable than protected vaginal intercourse. However, men’s pleasure ratings for unprotected vaginal intercourse were higher than women’s. Furthermore, men and women’s pleasure ratings for condom-protected intercourse were correlated with their actual condom use behaviors. Men’s “pleasure decrement” scores indicated a significantly greater reduction in pleasure ratings between unprotected and protected intercourse than women’s scores. Men who perceived a larger decrease in pleasure between unprotected and protected intercourse were less likely to have used condoms in the past 3 months than those who perceived a smaller decrease in pleasure. The results provide evidence that many people believe that condoms reduce sexual pleasure and that men, in particular, who believe that condoms decrease pleasure are less likely to use them. Condom promotion campaigns should work to emphasize the pleasure-enhancing aspects of condom use.     

Effects of Attractiveness and Social Status on Dating Desire in Heterosexual Adolescents: An Experimental Study

The present study examined to what extent adolescent dating desire is based on attractiveness and social status of a potential short-term partner. Further, we tested whether self-perceived mate value moderated the relationship between dating desire and attractiveness of a potential partner. Data were used from a sample of 1,913 adolescents aged 13–18. Participants rated the importance of various characteristics of a potential partner and also participated in an experimental vignette study in which dating desire was measured with either low or high attractive potential partners having either a high or low social status. The results showed that boys rated attractiveness as more important than girls, while social status was rated as relatively unimportant by both sexes. In addition, in the experimental vignette study, it was found that attractiveness was the primary factor for boys’ dating desire. Only when a potential partner was attractive, social status became important for boys’ dating desire. For girls, on the other hand, it appeared that both attractiveness and social status of a potential partner were important for their dating desire. Finally, boys and girls who perceived themselves as having a high mate value showed more dating desire toward an attractive potential partner compared to adolescents who perceived themselves as having a low mate value. The present results extend previous research by showing that attractiveness of a potential partner is important to both adolescent boys and girls, but social status does not strongly affect dating desire during this particular age period.     

Residential Staff’s Changing Attitudes Toward Parents of Children in their Care: Rationale and Healing Effects on Children,Parents, and Staff

A pilot project in Israel, regarding parent’s involvement in their children’s education in residential care was evaluated. The dual goals were changing staff’s attitudes toward parents, and empowering parents. During the school year, parents were invited to participate in bi-weekly dynamic group workshops in the residence (parents only and parents–children), and to 3–4 “Family Days,” in addition to sharing special parent–child summer camps. Results indicate considerable success: children, parents, and staff felt that the project had improved their ability to deal successfully with their everyday challenges, with parents viewing themselves as having been most rewarded.

Injection Drug Users’ Perspectives on Placing HIV Prevention and Other Clinical Services in Pharmacy Settings

In their role as a source of sterile syringes, pharmacies are ideally situated to provide additional services to injection drug users (IDUs). Expanding pharmacy services to IDUs may address the low utilization rates of healthcare services among this population. This qualitative study of active IDUs in San Francisco explored perspectives on proposed health services and interventions offered in pharmacy settings, as well as facilitators and barriers to service delivery. Eleven active IDUs participated in one-on-one semistructured interviews at a community field site and at a local syringe exchange site between February and May 2010. Results revealed that most had reservations about expanding services to pharmacy settings, with reasons ranging from concerns about anonymity to feeling that San Francisco already offers the proposed services in other venues. Of the proposed health services, this group of IDUs prioritized syringe access and disposal, clinical testing and vaccinations, and provision of methadone. Pharmacists’ and pharmacy staff’s attitudes were identified as a major barrier to IDUs’ comfort with accessing services. The findings suggest that although IDUs would like to see some additional services offered within pharmacy settings, this is contingent upon pharmacists and their staff receiving professional development trainings that cultivate sensitivity towards the needs and experiences of IDUs.     

Research Challenges: Implementing Standardized Outcome Measures in a Decentralized,Community-based Residential Treatment Program

With residential treatment services under pressure to produce outcome data, the process of executing research in such settings presents considerable challenges. This paper describes how a large, decentralized, community-based residential treatment program in southern and central Maine designed and implemented a research outcome process study using standardized measures on a variety of dimensions. The study’s rationale, process, challenges and findings are presented. Results indicated that the challenges to this work were minimized due to careful planning and collaboration by and with administration and treatment staff. Unique to this work was the process where a formal research approach was used in the context of a private, geographically diverse organization.     

Waddell’s Symptoms as Indicators of Psychological Distress, Perceived Disability, and Treatment Outcome

Introduction Waddell’s signs and symptoms have been described as patient presentations not within usual anatomic patterns of injury pathology. Waddell’s signs were thought to indicate psychological distress and were termed “non-organic findings”; similarly, Waddell’s symptoms were described as inappropriate and attributable to psychological features. Endorsement of more than two of Waddell’s symptoms is thought to be associated with psychological distress, disability, and poor treatment outcomes; however, this has not been empirically assessed. Methods The current study used a sample of patients (n = 108; 30% women) involved in a multi-disciplinary work hardening program provided by a third-party insurer. Patients who endorsed more than two of Waddell’s symptoms were compared with those who did not on demographic variables as well as self-report measures of psychological distress, disability, and treatment outcome. Results Patients who endorsed more than two of Waddell’s symptoms reported higher levels of psychological distress, perceived disability, pain intensity, and pain durations. Moreover, consistent with previous research on Waddell’s symptoms, patients endorsing more than two symptoms were also less likely to return to work. Conclusions Waddell’s symptoms were associated with increased perceived disability and pervasive pain interference. Patients who endorsed more than two symptoms were significantly less likely to return to work than those who endorsed zero, one, or two symptoms. Patients who endorsed more than two symptoms may indeed be affected by factors beyond tissue pathology that nonetheless warrant clinical attention. Waddell’s symptoms appear to have promise as a quick indicator of treatment complexity and outcome.     

Tutor Training,Evaluation Criteria and Teaching Environment Influence Students’ Ratings of Tutor Feedback in Problem-Based Learning

Aim In a problem-based learning (PBL) curriculum, tutor’s feedback skills are important. However, evaluation studies often show that students rate many tutors as ineffective in providing feedback. We explored whether this is related: (a) to tutors’ skills, and hence a teaching intervention might improve their performance; (b) to the formulation of the evaluation item, hence a more specific wording might help students better recognize a feedback when received; (c) to PBL teaching environment, and hence the tutors’ teaching unit might influence students’ ratings. Methods Students rated 126 tutors of 13 one-month teaching units over three consecutive years on their ability of providing feedback. We assessed how (a) a teaching intervention given between years 1 and 2, (b) a rewording of the evaluation item which took place in year 3, and (c) the tutors’ teaching unit, influenced students’ ratings. Results The ratings of tutors considered as effective by students at year 1 improved after the teaching intervention, while those of unsatisfactory tutors did not progress. However the ratings of the latter increased after reformulation of the evaluation item. This increase varied across teaching units. Discussion Students’ ratings of tutors’ ability to give feedback seem to vary in function of the tutors’␣training, of the formulation of the evaluation item, and of the tutors’ teaching environment. These variables should be considered for setting up effective strategies in faculty development.     

THE RELATIONSHIP BETWEEN HELPING ALLIANCE AND OUTCOME IN OUTPATIENT TREATMENT OF ALCOHOLICS: A COMPARATIVE STUDY OF PSYCHIATRIC TREATMENT AND MULTIMODAL BEHAVIOURAL THERAPY

During the last decades, a positive relation between a goodalliance and a successful therapy outcome has been demonstratedacross a variety of different therapeutic modalities. The relationshipbetween alliance and drinking outcome in long-term treatmentof alcoholics (12 months or more) has not, as far as we know,been presented. In the present study, alcoholics were randomizedto two outpatient treatment programmes; multimodal behaviouraltherapy (MBT) and psychiatric treatment based on a psychodynamicapproach (PT). As part of the study, analyses were performedconcerning differences in alliance between the two treatmentmodels (MBT, n= 17; PT, n= 18), and concerning the relationshipbetween alliance and treatment outcome. A Swedish version ofthe Helping Alliance Questionnaire was used to measure alliance.All therapy sessions were tape-recorded. An independent researcherrated the patient's and therapist's contribution to the allianceat the third session (early alliance). Early patient and therapistalliances were not related to sociodemographic data or initialmeasures of alcohol severity, psychiatric symptoms, or personalitystructure in either therapy. Early therapist alliance was betterin MBT in comparison with PT. For MBT patients, a significantpositive correlation was found between early patient allianceand mood dimensions at 6 months. There were no significant positivecorrelations between early alliance and drinking outcome duringthe course of treatment and in the third year after start oftreatment. Mood and drinking outcome also showed low correlations.In conclusion, an initial positive alliance seems insufficientto reduce alcohol misuse. The relationship between early allianceand improvement in alcohol misuse needs to be further investigated.     

Conditionally Sexual: Men and Teenage Boys with Moderate to Profound Intellectual Disability

This article presents qualitative research data about the sexuality of men and teenage boys with moderate to profound intellectual disability. Research findings pointed to a conditional construct of sexuality based within a biopsychosocial framework. The notion Conditionally Sexual represents the perceived limitations, within a rights-based discourse, of these men and teenage boys’ sexuality. The limitations to person-centred service delivery from a policy vacuum in the area of sexuality and intellectual disability represents a major challenge for paid staff. We suggest that a move toward better understanding how to support such a conditional sexual construct will assist the development of a healthy masculine sexuality for men and boys with intellectual disability.     

Adolescent Satisfaction with Brief Motivational Enhancement for Alcohol Abuse

Although many investigations point to the importance of treatment satisfaction and working alliance as predictors of treatment engagement and outcome, few studies have closely examined these issues among adolescents. This study investigates satisfaction among a nonclinical adolescent sample participating in a school-based alcohol-prevention program. Adolescents self-selected to one of three formats: individual, group, and website. Three hundred nineteen satisfaction measures completed at the time of each participant’s final session were used for analyses. Hierarchical regression analyses examined predictors of consumer satisfaction. In general, greater participation in the program was significantly related to satisfaction. Students who participated in the group and individual formats reported greater satisfaction than students who participated in the website format. Current alcohol users were less satisfied with the session focusing on how experimental use can lead to problem use; lifetime abstainers were more satisfied with the session focusing on stress and coping. These analyses have implications for informing future adolescent school-based interventions for alcohol problems.     

Trajectories of Overweight Among US School Children: A Focus on Social and Economic Characteristics

Much of the research examining the patterns, timing, and socioeconomic characteristics of child overweight has been limited by the lack of longitudinal nationally representative data with sufficiently large or diverse samples. We used the Early Childhood Longitudinal Study-Kindergarten Cohort (ECLS-K), a nationally representative sample of US kindergartners, to identify three distinct patterns of weight gain from kindergarten through eighth grade. The largest group (boys: 59%, girls: 55%) was characterized as having consistently normal weight whereby BMI percentile remained below the 85th percentile. The remaining children (boys: 41%, girls: 45%) fell either into a class characterized as always overweight/at risk of overweight (boys: 27%, girls: 25%) or gradually becoming overweight/at risk for overweight (boys: 15%, girls 20%). We found some evidence that the relationship between socioeconomic status and children’s health may operate differently across gender. Among girls, low parental income and education were both significant risk factors for the gradual onset of overweight after beginning Kindergarten. Parental income or changes in parental income were not related to boys’ risk of developing overweight after entering Kindergarten; only parents’ education. We found that while children of immigrants display higher levels of overweight/at risk for overweight at each grade level, the children of immigrant parents who have had less exposure to the US were more likely to experience early and sustained overweight throughout elementary and middle school, particularly among boys. High rates of overweight as early as kindergarten, combined with race/ethnic differences suggest that interventions should focus on pre-school children’s environments.     

Five-year outcome from eating disorders: Relevance of personality disorders

In order to assess the relationship of personality disorder and eating disorder outcome 30 eating disordered patients were followed up 4–5 years after taking part in a study examining the prevalence of personality disorders in eating disordered individuals. Subjects with personality disorders did not differ from those without personality disorders in the amount of symptomatic change over time, although their psychopathology generally remained more severe. The relationship of personality disorder and clinical outcome ratings varied depending on the personality measure. SCID-II personality disorder diagnoses were not significantly associated with outcome ratings, but were related to a greater likelihood to be hospitalized and treated with psychotropic medications. Results with a new personality measure, the Wisconsin Personality Inventory, did display an association between personality disturbance and eating disorder outcome ratings and also suggested that borderline personality was a significant predictor of outcome. © 1994 by John Wiley & Sons, Inc.     

Prolonged Exposure Treatment of Chronic PTSD in Juvenile Sex Offenders: Promising Results from Two Case Studies

Prolonged exposure (PE) was used to treat chronic PTSD secondary to severe developmental trauma in two adolescent male sex offenders referred for residential sex offender treatment. Both youth were treatment resistant prior to initiation of PE and showed evidence of long-standing irritability and depression/anxiety. Clinical observation and treatment outcome data suggest that marked progress was made in reducing PTSD symptoms and improving the youth’s overall mood after 16–19 PE sessions. Abatement of PTSD appeared to have a parallel effect on improving the youth’s overall investment in his sex offender treatment and his relationship with his therapists. Results suggest that PE is feasible for treating PTSD in juvenile sex offenders, highlight the potential relevance of PTSD intervention in these youth, and help to emphasize the need to conduct more rigorous evaluations (e.g. randomized designs) of the effect of PE in improving sex offender treatment outcomes of trauma exposed youth.     

Perceived Parental and Peer Disapproval Toward Substances: Influences on Adolescent Decision-Making

This study investigated the relative influence of perceived parent and peer disapproval for using drugs on youth intentions to use drugs. In a cross-sectional design, sixth and eighth grade students (N = 1,649) completed surveys that included measures of parent disapproval, peer disapproval, and intentions to use drugs in the future. Parent influences were more salient for sixth graders, whereas peer influences were predominant for eighth graders. Peer disapproval was significantly evident in the sixth grade sample, as was parent disapproval in the eighth grade sample. Additionally, girls’ drug use intentions were higher than were boys’. These findings suggest that parents can have a robust protective role over and above peer influences and that girls’ intentions to use substances deserve increased attention. Editors’ Strategic Implications: These findings, if replicated, should help practitioners develop developmentally appropriate strategies and programs for substance use prevention.