Caitlin Smith

Motivational Interviewing for adolescent substance use: A review of the literature☆

Motivational Interviewing (MI) is a widely-used approach for addressing adolescent substance use. Recent meta-analytic findings show small but consistent effect sizes. However, differences in intervention format and intervention design, as well as possible mediators of change, have never been reviewed. This review of the literature summarizes the most up-to-date MI interventions with adolescents, looks at differences between intervention format and design, and discusses possible theory-based mechanisms of change. Of the 39 studies included in this review, 67% reported statistically significant improved substance use outcomes. Chi square results show no significant difference between interventions using feedback or not, or interventions combined with other treatment versus MI alone. The need for systematic investigation in theory-based mechanisms of change is presented.

The Contribution of Cultural Competence to Evidence-Based Care for Ethnically Diverse Populations

Despite compelling arguments for the dissemination of evidence-based treatments (EBTs), questions regarding their relevance to ethnically diverse populations remain. This review summarizes what is known about psychotherapy effects with ethnic minorities, with a particular focus on the role of cultural competence when implementing EBTs. Specifically, we address three questions: (a) does psychotherapy work with ethnic minorities, (b) do psychotherapy effects differ by ethnicity, and (c) does cultural tailoring enhance treatment effects? The evidence suggests that psychotherapy is generally effective with ethnic minorities, and treatment effects are fairly robust across cultural groups and problem areas. However, evidence for cultural competence is mixed. Ethnic minority-focused treatments frequently incorporate culturally tailored strategies, and these tailored treatments are mostly efficacious; yet support for cultural competence as a useful supplement to standard treatment remains equivocal at best. We also discuss research limitations, areas for future research, and clinical implications.

From counselor skill to decreased marijuana use: does change talk matter?

Client language about change, or change talk, is hypothesized to mediate the relationship between counselor fidelity in motivational interviewing (MI) and drug use outcomes. To investigate this causal chain, this study used data from an MI booster delivered to alternative high school students immediately after a universal classroom-based drug abuse prevention program. One hundred and seventy audio-recorded MI sessions about substance use were coded using the motivational interviewing skill code 2.5. Structural equation modeling showed that percentage of change talk on the part of the client mediated three of the four relationships between MI quality indicators and marijuana outcomes, while percentage of reflections of change talk showed a main effect of counselor skill on marijuana outcomes. Findings support change talk as an active ingredient of MI and provide new empirical support for the micro-skills of MI.

Characterizing the sexual abuse experiences of young adolescents

The purpose of this descriptive study was to: (a) compare the demographics of maltreated youth initially labeled as sexually abused by the Department of Child and Family Services (DCFS) to maltreated youth classified as sexually abused using current and past case records, (b) identify differences in sexual abuse experiences and types of perpetrators between boys and girls, and (c) provide a detailed description of the sexual abuse experiences for boys and girls. Participants were youth ages 9-12 years old with a recent maltreatment allegation. The Maltreatment Case Record Abstraction Instrument (MCRAI) was used to code child welfare records of 303 maltreated youth of whom 60 experienced sexual abuse. Perpetrators were classified by gender into four categories (biological parent, parental figure, relative, and unrelated) and type of abuse was classified into three categories (penetrative, contact without penetration, and non-contact). Using Chi-Square tests, perpetrator categories and sexual abuse types were compared by child gender for significant differences. Only 23 (38.3%) of the 60 sexually abused youth were labeled as sexually abused in the most recent DCFS report when they entered the study. About three-quarters of the sexually abused youth experienced non-penetrative physical contact, 40% experienced penetration, and 15% experienced sexual abuse without physical contact. Most youth (91.7%) were victimized by a male, and 21.7% were abused by a female. Youth experienced a large range of sexual abuse experiences, the details of which may be important for exploration of consequences of childhood sexual abuse.

Overweight and obesity among Hispanic children entering foster care: a preliminary examination of polyvictimization.

This retrospective medical chart review examined the prevalence of overweight/obesity (≥85th percentile) and obesity (≥95th percentile) in Hispanic foster children aged 2–18 years in Los Angeles, California. Logistic regression was used for boys and girls separately to analyze polyvictimization (i.e., one vs. two or more types of maltreatment), type of maltreatment (abuse vs. neglect), and age-group as risk factors for overweight and obesity. Almost 40% of participants were overweight/obese, with the highest prevalence (47.7%) observed among children aged 12–18. Children aged 6–18 were at an increased risk of overweight/obesity and obesity compared with children aged 2–5. Although polyvictimization has been shown to have adverse health effects, in this study, it was related to slightly lower odds of obesity for boys but was unrelated to high weight for girls. Addressing the obesity epidemic among Hispanic foster children is vital to preventing continued obesity and the development of obesity-related health problems, especially by focusing on important community and family influences.

Weight changes in children in foster care for 1 year

OBJECTIVE The aims of this study of predominately racial/ethnic minority children in foster care (N=360, birth to 19 years old) in Los Angeles, CA were to examine the (1) prevalence of obesity (≥ 95 percentile) and overweight/obese (≥ 85 percentile) upon entrance to foster care (T1) and after 1 year in foster care (T2); (2) comparison of high weight categories to national statistics; (3) relationship of changes in weight status to age, reason for entry into foster care, and placement. METHODS Chi-square test and McNemar test comparing paired proportions were used to determine whether there were significant changes in the proportion of high weight categories between T1 and T2. Chi-square test or Fishers exact test were used to evaluate the association between age, placement, and reason for foster care with the change in weight category. Changes in weight were categorized as (1) decreased in weight, (2) remained at overweight or obese, (3) increased in weight, or (4) remained normal. RESULTS The proportion of obese and obese/overweight children between ages 2 and 5 were significantly lower at T2 than T1. There were no significant changes in the prevalence of obesity for the total population at T2. Children age 6 or older had a higher prevalence of obesity and overweight/obesity compared to national statistics. Of children at all ages, 64.7% of children of all ages entered foster care with a normal weight and stayed in the normal range during their first year in foster care, 12.2% decreased their weight, 15.4% remained overweight or obese, and 7.7% increased their weight. Age and parental substance use was related to change in weight category from T1 to T2. CONCLUSION Children did not become more overweight or obese in foster care; however 28% of the children were obese or overweight upon entry into foster care. Children who are 6 years or older and obese upon entering foster care should be targeted for weight reduction. The pediatric community and child welfare system need to work together by including weight percentiles in the foster care file and training/monitoring child welfare caregivers in weight reduction interventions.

Unrecognized Posttraumatic Stress Disorder as a Treatment Barrier for a Gang-Involved Juvenile Offender

This study examines the case of GH, an 18-year-old Latino male participating in an employment-based delinquency intervention for gang-affiliated youth. Although postintervention measures revealed that GH showed gains on key outcomes (i.e., delinquency, employment), he experienced sporadic treatment setbacks (e.g., work absenteeism, fighting) that disrupted his progress. A comprehensive psychological assessment suggested that his aggressive, illegal behavior and difficulty maintaining employment could have been influenced by previously undiagnosed posttraumatic stress disorder (PTSD). Excerpts from counseling sessions illustrated how reactive aggression, hypervigilance, sleep disruptions, and emotional numbing could have interfered with treatment gains and ultimately contributed to GHs re-arrest. Implications for early, accurate identification of PTSD in delinquency interventions for gang youth are discussed.

Nasal Spreading as Defective Gestural Deactivation

Nasal spreading (also called nasal vowel-consonant harmony) is a process by which a nasal segment in a word triggers nasalization of its surrounding segments. This paper proposes a reanalysis of this phenomenon using gestures as the units of phonological representation in order to more accurately capture its crosslinguistic typological patterns. Nasal spreading proceeds unboundedly, potentially resulting in spreading of nasality throughout an entire word. However, it is also common for the spread of nasality to be arrested by glides, liquids, or obstruents, a property known as blocking. This is exemplified in Warao (isolate; Venezuela), in which nasality spreads progressively from a triggering nasal consonant or vowel, affecting following vowels, glides, and glottal consonants (1a-d) but is arrested by liquids and obstruents, as in (1e-h) (Osborn 1966):

Commitment Language and Homework Completion in a Behavioral Employment Program for Gang-Affiliated Youth

Research with substance-abusing samples suggests that eliciting commitment language during treatment may improve motivation to change, increase treatment engagement, and promote positive treatment outcomes. However, the relationship between in-session client language and treatment success is not well-understood for youth offender populations. This study evaluated the relationship between commitment language, treatment engagement (i.e., homework completion), and weekly employment outcomes for six gang-affiliated juvenile offenders participating in an employment counseling intervention. Weekly counseling sessions were audio-recorded, transcribed, and coded for commitment language strength. Multilevel models were fit to the data to examine the relationship between commitment language and counseling homework or employment outcomes within participants over time. Commitment language strength predicted subsequent homework completion but not weekly employment. These findings imply that gang-affiliated delinquent youth who express motivation to change during employment counseling will be more likely to comply with counselor-initiated homework. Further research on counselor techniques for promoting commitment language among juvenile gang offenders is needed.

On distinguishing articulatory configurations and articulatory tasks: Tamil retroflex consonants

Speech production can be described in multiple coordinate frames: articulatory configurations, gestural tasks, and acoustic patterns. Examination of the achievement of retroflex stops and liquids in Tamil suggests that we must consider separately the gestural task of apical post-alveolar constriction and the articulatory maneuver to achieve the task. The maneuver of the tongue during retroflex consonants varies across vowel contexts. Specifically, in the symmetrical intervocalic contexts between back vowels /a/ and /u/, an apical post-alveolar constriction is achieved by curling back the tongue. In the context of high front vowel /i/, a laminal post-alveolar constriction is achieved by bunching the tongue. However, the location of retroflex consonant constriction within the vocal tract is consistent across all of these vowel contexts, suggesting that the constriction task remains the same. Variation in the articulatory configuration of the retroflex in the two contexts was quantified through Gaussian curvature functions at fourteen points along the tongue, sampled at evenly spaced points throughout the vocal tract, on every other gridline of a polar-rectangular grid in every frame in each utterance. The empirical results support the notion that the articulatory configuration coordinate frame and the gestural task frame provide separate, but related, descriptions of speech production.