A. Kathleen Burlew

The Impact of a Child with Sickle Cell Disease on Family Dynamics

This paper has reviewed research and other papers that have furthered our understanding of the impact of the presence of a child with sickle cell disease on the family. The research suggests that the primary parent in such a family experiences additional emotional strain much like primary parents of children with other chronic illnesses have been found to exhibit. The research also suggests that the ill childs presence influences interpersonal relationships within the family. Specifically, there is some evidence that the relationship between the parents and the relationship between the parent and other offspring may be affected adversely. The only evidence for an adverse impact on the relationship between the parent and the chronically ill child was in our research when considering only single-parent families. The research also suggests that the family environment is affected. In particular, the research suggests that the level of conflict and organization within the family was less favorable than within the control families. Moreover, the research suggests that the childs presence reduces the ability of the primary parent to participate in social activities outside of the family. Secondary parents, on the other hand, report less satisfaction with the extent to which their own individual needs are being met within the family. The available research also suggests that other factors mediate the impact of the childs illness on the family. In particular, parents with more knowledge about the illness and more social support available appear to cope more favorably with the illness. Moreover, the available research also suggests that the family also impacts on how the patient responds to the illness. Specifically, the more psychosocial stressors within the family, the less effectively the patient copes with the illness. In addition, the more social support available to the patient from the family and other significant others, the more likely the patient is to comply with the treatment regimen. Finally, two methodological issues have been discussed. First, a tendency is evident for parents to deny any impact on the family when asked directly but to demonstrate the impact when the responses of these parents are compared to the responses of a comparison group. This suggests a need for more studies that involve a comparison group in the design. Second, the small sample sizes in many of the studies reflect the lack of adequate sample in individual geographic locales. This suggests a need for more collaborative research projects such as the CSSCD project to increase sample size.

Measures of Racial Identity: An Overview and a Proposed Framework:

Since its inception, the area of racial identity has undergone multiple revisions in both the understanding of the theoretical construct and in the development of the assessment techniques. James Bayton and Charles Thomas laid the foundation for much of what has been investigated regarding racial identity to date. This paper focuses on the diverse instruments utilized in the assessment of racial identity among African American adults. The purpose of the review is to suggest and provide a framework for conceptualizing racial identity. Thus, the authors categorize the instruments into one of four broad approaches: (1) developmental approaches, (2) Africentric approaches, (3) group-based approaches, and (4) measures of racial stereotyping. Given the varied theoretical underpinnings of the measures and widely divergent results obtained when using different instruments, researchers are encouraged to select the measure of racial identity that most accurately reflects the nature of the research question proposed.

Conducting Research with Racial/Ethnic Minorities: Methodological Lessons from the NIDA Clinical Trials Network

Background: Multiple studies in the National Institute on Drug Abuse Clinical Trials Network (CTN) demonstrate strategies for conducting effective substance abuse treatment research with racial/ethnic minorities (REMs). Objectives: The objectives of this article are to describe lessons learned within the CTN to (1) enhance recruitment, retention, and other outcomes; (2) assess measurement equivalence; and (3) use data analytic plans that yield more information. Method: This article includes background information and examples from multiple CTN studies on inclusion, measurement, and data analysis. Results and Conclusions: Seven recommendations are included for conducting more effective research on REMs.

Using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) to Detect Psychological Distress and Dysfunction in a State Correctional Setting

Approximately 1.3 million men and 93,000 women are currently detained in state and federal correctional facilities. The ability to identify upon admission to a correctional facility those individuals who either have or are at an increased risk for developing significant psychological difficulties is crucial in order to allow early detection of inmates requiring mental health services. This study investigates the frequency with which 34,281 male and 6,878 female inmates from a state corrections facility reported significant levels of distress and dysfunction upon intake to the correctional system as measured by various clinical scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Results indicate that a substantial proportion of incarcerated adults reported significant levels of distress across a variety of psychological, social, and behavioral domains.

REAL MEN ARE SAFE-CULTURALLY ADAPTED: UTILIZING THE DELPHI PROCESS TO REVISE REAL MEN ARE SAFE FOR AN ETHNICALLY DIVERSE GROUP OF MEN IN SUBSTANCE ABUSE TREATMENT

Real Men Are Safe (REMAS) was effective at reducing the number of unprotected sexual occasions for men in substance abuse treatment compared to an HIV education control intervention. Utilizing a modified Delphi process, modules from REMAS were compared to similar-content modules from other CDC-approved, culturally tailored HIV prevention interventions. Utilizing ratings and recommendations obtained from an independent expert panel, REMAS was subsequently revised to be more culturally adapted for an ethnically diverse group of men. Ratings suggested REMAS was culturally fair, but that in certain areas the culturally tailored interventions were more in tune with African American and Hispanic men. Revisions to REMAS include an added focus on how culture, social norms, and upbringing affect a mans sexual behavior and relationships.

A cross‐sectional assessment of the long term effects of brief strategic family therapy for adolescent substance use

BACKGROUND Young adult drug use and law-breaking behaviors often have roots in adolescence. These behaviors are predicted by early drug use, parental substance use disorders, and disrupted and conflict-ridden family environments. AIM To examine long-term outcomes of Brief Strategic Family Therapy (BSFT) compared to treatment as usual (TAU) in the rates of drug use, number of arrests and externalizing behaviors in young adults who were randomized into treatment conditions as adolescents. DESIGN 261 of 480 adolescents who had been randomized to BSFT or TAU in the BSFT effectiveness study were assessed at a single time, 3-7 years post randomization. METHODS Assessments of drug use, externalizing behaviors, arrests and incarcerations were conducted using Timeline Follow Back, Adult Self Report, and self-report, respectively. Drug use, arrests and incarcerations were examined using negative binomial models and externalizing behaviors were examined using linear regression. RESULTS When compared with TAU, BSFT youth reported lower incidence of lifetime (IRR = 0.68, 95%CI [0.57, 0.81]) and past year (IRR = 0.54, 95%CI [0.40, 0.71]) arrests; lower rates of lifetime (IRR = 0.63, 95%CI [0.49, 0.81]) and past year (IRR = 0.70, 95%CI [0.53, 0.92]) incarcerations; and lower scores on externalizing behaviors at follow-up (B = -0.42, SE = .15, p = .005). There were no differences in drug use. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE BSFT may have long term effects in reducing the number of arrests, incarcerations and externalizing problems. These effects could be explained by the improvements in family functioning that occurred during the effectiveness study. This study contributes to the literature by reporting on the long term outcomes of family therapy for adolescent drug abuse.

MMPI-2 validity scale characteristics in a correctional sample.

The current study investigated the proportion of content-nonresponsive and content-responsive faking Minnesota Multiphasic Personality Inventory-2 (MMPI-2) protocols in a state corrections sample. Participants were 51,486 inmates who completed the MMPI-2 at the time they entered the Ohio Department of Rehabilitation and Correction system. Overall, approximately 79% of the study participants produced valid profiles. Of the entire study sample, 11.3% produced content-nonresponsive profiles, and 9.4% produced content-responsive faking profiles. African Americans produced a higher proportion of content-nonresponsive profiles than Caucasians, and women were slightly more likely than men to produce content-responsive faking profiles. Differences in level of education between African Americans and Caucasians did not account for the disparity in content-nonresponsive profiles. Implications for current practice and future research are discussed.

Does change in readiness influence retention among African American women and men in substance abuse treatment

ABSTRACT African Americans are less likely than other racial groups to engage in and complete outpatient substance abuse treatment. The current study, conducted as a secondary analysis of a multisite randomized clinical trial, examined whether readiness to change (RTC) over time influences retention and whether gender moderates the relationship between changes in RTC and retention among 194 African American women and men. Participants completed the University of Rhode Island Change Assessment at baseline and at the end of the 16-week study. Findings revealed a significant relationship between RTC over time and retention. Specifically, the more RTC increased throughout the 16-week study, the longer participants remained in treatment. In addition, gender moderated the relationship between changes in RTC and retention, with a stronger association between changes in RTC and retention among men relative to women. One approach to improving substance abuse treatment retention rates is to focus on increasing RTC during treatment, especially among African American men.

Measuring fidelity to a culturally adapted HIV prevention intervention for men in substance abuse treatment

A fidelity measure was developed for use with Real Men Are Safe-Culturally Adapted (REMAS-CA), an HIV prevention intervention for ethnically diverse men in substance abuse treatment. The aims of this analysis were to: 1) assess the reliability of the Fidelity Rating and Skill Evaluation (FRASE); 2) measure improvement in therapist competence and adherence over time while delivering REMAS-CA; and 3) identify which modules of REMAS-CA were most difficult to deliver. Results showed that, 1) the FRASE was a reliable instrument; 2) therapists achieved adequate adherence and competence after training and demonstrated significant improvement over time in Global Empathy; and 3) Sessions 4 and 5 of REMAS-CA contained the most challenging modules for therapists to deliver. Recommendations for future REMAS-CA therapist trainings and fidelity monitoring are made.

The case for considering rather than ignoring race/ethnicity in substance abuse research

The aim statement for this journal describes our emphasis on studies and research that contribute to understanding ethnic and cultural variation in alcohol, tobacco, and licit and illicit forms of substance use and abuse. Despite a promising body of work that examines race/ethnicity in substance abuse, some scholars continue to blindly apply findings based on other groups to specific racial/ethnic groups. Others attend to diversity by including a small, albeit representative, sample of an ethnic group and then concluding that the overall findings apply to that group. In the future, whenever colleagues question the need for a more thorough examination of racial/ethnic differences in their work, I will refer them to this issue. Overall, the set of articles demonstrates racial/ethnic differences in the link between mental health risk factors and substance abuse and the characteristics of clients upon treatment entry. Other articles demonstrate variations in the prevalence of drug use patterns within and across age groups. Finally, an examination of issues related to operationally defining race/ethnicity in substance abuse research is also included. The presence of mental disorders as a risk factor for substance abuse has been widely investigated. However, racial/ethnic differences in the relationship of mental disorders to substance abuse have not received much attention. The article by Sumstine and colleagues makes a strong case for devoting more thought to such differences in future work. Specifically, although inattention predicted stimulant drug use in both White and Latino college students, inattention was also associated with cocaine use among Latinos but not Whites. Moreover, psychological distress was linked to marijuana use among Whites but to tobacco use and prescription painkillers among Asians. These differences may have significant implications for effective services for specific racial/ethnic groups. Two other articles demonstrate racial/ethnic differences in the characteristics that clients bring to substance abuse treatment. Bart and colleagues described differences in the psychosocial characteristics that Hmong clients bring to methadone treatment compared to others (primarily Whites, Blacks, none defined