Abram Rosenblatt

Evidence For Terror Management Theory: I. The Effects of Mortality Salience on Reactions to Those Who Violate or Uphold Cultural Values

On the basis of terror management theory, it was hypothesized that when mortality is made salient, Ss would respond especially positively toward those who uphold cultural values and especially negatively toward those who violate cultural values. In Experiment 1, judges recommended especially harsh bonds for a prostitute when mortality was made salient. Experiment 2 replicated this finding with student Ss and demonstrated that it occurs only among Ss with relatively negative attitudes toward prostitution. Experiment 3 demonstrated that mortality salience also leads to larger reward recommendations for a hero who upheld cultural values. Experiments 4 and 5 showed that the mortality salience effect does not result from heightened self-awareness or physiological arousal. Experiment 6 replicated the punishment effect with a different mortality salience manipulation. Implications for the role of fear of death in social behavior are discussed.

Quality of Publicly-Funded Outpatient Specialty Mental Health Care for Common Childhood Psychiatric Disorders in California

OBJECTIVE To describe the documented adherence to quality indicators for the outpatient care of attention-deficit/hyperactivity disorder, conduct disorder, and major depression for children in public mental health clinics and to explore how adherence varies by child and clinic characteristics. METHOD A statewide, longitudinal cohort study of 813 children ages 6.0-16.9 years with at least 3 months of outpatient care, drawn from 4,958 patients in 62 mental health clinics in California from August 1, 1998, through May 31, 1999. The main outcome was documented adherence to quality indicators based on scientific evidence and clinical judgment, assessed by explicit medical record review. RESULTS Relatively high adherence was recorded for clinical assessment (78%-95%), but documented adherence to quality indicators related to service linkage, parental involvement, use of evidence-based psychosocial treatment, and patient protection were moderate to poor (74.1%-8.0%). For children prescribed psychotropic medication, 28.3% of the records documented monitoring of at least one clinically indicated vital sign or laboratory study. Documented adherence to quality indicators varied little by child demographics or clinic factors. CONCLUSION Efforts to improve care should be directed broadly across clinics, with documentation of safe practices, particularly for children prescribed psychotropic medication, being of highest priority.

Criminal behavior and emotional disorder: comparing youth served by the mental health and juvenile justice systems.

This study explored whether youth involved in joint service systems differed from single-agency users in terms of types of crimes committed and clinical functioning. Data from 4,924 youth involved in one countys public mental health and juvenile justice service systems were examined. Twenty percent of those youth receiving mental health services had recent arrest records, and 30% of youth arrested received mental health services. Of all youth arrested in the county, mental health service users had more arrests than non-mental health service users. A subsample of 94 mental health service users with arrests was matched on demographics with 94 mental health service users without arrests. Youth with arrests had a higher frequency of conduct disorder, higher Child Behavior Checklist Externalizing and Total Problem Scale scores, and more functional impairment on the Child and Adolescent Functional Assessment Scale as compared to youth without arrests. Implications for behavioral health service delivery were discussed.

Examining the world of the depressed: do depressed people prefer others who are depressed?

Two studies were conducted to examine the interpersonal world of the depressed person. In Study 1, depression levels and perceptions of depressed and nondepressed people and their best friend were assessed to test the hypothesis that depressed Ss have best friends who are themselves more depressed than the best friends of nondepressed Ss. The hypothesis was confirmed, suggesting that depressed persons may prefer others who also tend toward depression. To examine this possibility, in Study 2 depressed and nondepressed college students spoke with one another in either depressed-depressed, nondepressed-depressed, or nondepressed-nondepressed pairs. It was found that depressed Ss felt worse than nondepressed Ss after speaking with nondepressed targets, but not after speaking with depressed targets. There were no differences in liking or in perceived similarity between the groups. Implications for the social world of the depressed person are discussed.

Bows and ribbons, tape and twine: Wrapping the wraparound process for children with multi-system needs

The wraparound process for children with multi-system needs is one of the most innovative and popular reform efforts in childrens services. Nonetheless, the articles in this special issue are indicative of a service reform process that is still maturing and evolving. In this commentary, three key questions regarding the wraparound process are posed: (a) What is wraparound? (b) What is the current state of research regarding wraparound services? and (c) What are the implications for the future? It is argued that the future of wraparound depends at least in part on: (a) carefully defining the wraparound process, including how to best integrate the process with reforms based on the principles of a comprehensive system of care; and (b) making a strong commitment at all levels to the process of cumulative knowledge, of building and creating innovative research and program efforts over time, one upon the other. It is concluded that a failure to invest in careful definition, refinement, implementation, and research on the wraparound process consitutes a failure to invest in children and families with multi-system needs.

Integrating systems of care in California for youth with severe emotional disturbance. I. A descriptive overview of the California AB377 evaluation project

This paper presents an overview and an initial set of findings from an evaluation in three California counties of a replication of an integrated system of care for youth suffering from serious emotional disturbance. The development of the innovative system of care was pioneered in Ventura County, California, and the replications were legislatively enabled through AB377 (Assembly Bill 377). This paper focuses on one set of variables being studied in the evaluation: the characteristics of the youth enrolled in the care systems. This variable is important because personnel in the counties are explicitly deciding which youth are eligible for services given limited available public resources. Within the model system of care, clinical severity and risk status (being at-risk ofor in out-of-home placement) are used as the criteria for enrollment with the intent of serving those most in need as effectively as possible. The gender, age, clinical diagnosis, ethnicity, and global assessment of functioning (GAF) scores of these youth are presented. In general, the youth served are male, have low GAF scores, and predominantly receive clinical diagnoses of affective disorders and disruptive behavior disorders. African-Americans are overrepresented in the care systems relative to the general population and Asian-Americans are underrepresented.

DEPRESSION AND INTERPERSONAL ATTRACTION: THE ROLE OF PERCEIVED SIMILARITY

We hypothesized that depressed individuals are generally viewed as dissimilar and that this perceived dissimilarity contributes to negative reactions to the depressed. In addition, we hypothesized that if perceived similarity affects liking of depressed individuals, then nondepressed subjects should prefer nondepressed targets, but depressed subjects should not share this preference. To test these hypotheses, depressed and nondepressed subjects received information about two targets, both either depressed or nondepressed, one attitudinally dissimilar and one attitudinally similar. They were then asked to fill out an attraction measure and an interest in meeting measure for each target. The results clearly supported the primary hypotheses, demonstrating that nondepressed subjects preferred nondepressed targets and perceived them as more similar than depressed targets, and that this preference for nondepressed targets is not shared by depressed subjects. Tests of supplementary hypotheses also confirmed that depressed subjects perceive their best friends as being more depressed and more dissimilar than do nondepressed subjects. The implications of these findings for the social world of the depressed were discussed.

Assessing the effectiveness of care for youth with severe emotional disturbances: Is there agreement between popular outcome measures?

Limited information exists regarding how some popular measures for assessing the effectiveness of services to children with severe emotional disturbance interrelate when used as part of ongoing outcome accountability systems. This article examines the interrelationships—at intake and over time—between the Child Behavior Checklist (CBCL), the Youth SelfReport (YSR), the Child and Adolescent Functional Assessment Scale (CAFAS), andDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) clinical diagnoses across six California care systems. At intake, there were mild to moderate relationships between the clinical diagnosis, the CAFAS, the CBCL, and the YSR. These relationships were not as strong as those found in other studies conducted in more controlled research environments. There was limited agreement among the CAFAS, the CBCL, and the YSR regarding the outcomes of the youths served. These findings raise questions regarding translating measures from research settings to clinical environments and reconciling differences between outcome measures.

Use of mental health services among severely emotionally disturbed children and adolescents in San Francisco

This study examined the mental health services available to severely emotionally disturbed children and adolescents in San Francisco. Social, familial, developmental, and clinical data—as well as service use histories—on 192 youths were collected. Results indicated high levels of family dysfunction, physical and sexual abuse, and neglect in the total study population. The study also identified case history and demographic factors that were associated with repeated psychiatric inpatient hospitalizationand high annual rates of change in residential placement. These factors included being male, older, non-English-speaking, and having a history of physical and sexual abuse. The impact of the service system on the lives and course of illness of these youth is discussed and future directions for research are suggested.

Managing what you measure: creating outcome-driven systems of care for youth with serious emotional disturbances.

This article presents the California System of Care Model for youth with severe emotional disturbances as an illustration of how ongoing assessment of the costs and outcomes of service delivery can be an integral part of a service delivery model. The core of this model, developed initially in Ventura County, California, is a five-step planning process that guides care system development and implementation. The implications of each stage of the planning process for evaluation and feedback at the child, family, and system levels are highlighted. A set of principles for selecting outcome measures deriving from the planning process are also presented that, in conjunction with the planning model, serve as guidelines for establishing outcome measures within care systems. The resulting specific plan for measuring system- and client-level outcomes deriving from this process, along with challenges to the implementation of the outcome management plan, is described.