Charles W. Mueller

Longitudinal Predictors of Youth Functional Improvement in a Public Mental Health System

The present study examined youth characteristics that predict level of impairment at entry into a system of care and rate of improvement over the course of service provision. Youth characteristics studied included gender, age, specific diagnostic categories, and comorbidity. A total of 2,171 youth served in a state-wide public mental health system were included in the study. Hierarchical linear modeling was used to analyze longitudinal data derived from quarterly ratings of functional status. Gender had no relationship to initial level of impairment or rate of improvement. Older youth, those with disruptive behavior disorders, and those with more than one DSM diagnosis were more impaired at system entry. Those with attentional disorders began services less impaired. Older youth improved at faster rates. Youth with a disruptive behavior disorder diagnosis improved at slower rates. Neither comorbidity nor the presence of a mood or attentional disorder affected the rate of improvement. Both researchers and systems of care developers should consider these patterns in their future work.

Engineering Youth Service System Infrastructure: Hawaii's Continued Efforts at Large-Scale Implementation Through Knowledge Management Strategies

Hawaiis Child and Adolescent Mental Health Division provides a unique illustration of a youth public mental health system with a long and successful history of large-scale quality improvement initiatives. Many advances are linked to flexibly organizing and applying knowledge gained from the scientific literature and move beyond installing a limited number of brand-named treatment approaches that might be directly relevant only to a small handful of system youth. This article takes a knowledge-to-action perspective and outlines five knowledge management strategies currently under way in Hawaii. Each strategy represents one component of a larger coordinated effort at engineering a service system focused on delivering both brand-named treatment approaches and complimentary strategies informed by the evidence base. The five knowledge management examples are (a) a set of modular-based professional training activities for currently practicing therapists, (b) an outreach initiative for supporting youth evidence-based practices training at Hawaiis mental health-related professional programs, (c) an effort to increase consumer knowledge of and demand for youth evidence-based practices, (d) a practice and progress agency performance feedback system, and (e) a sampling of system-level research studies focused on understanding treatment as usual. We end by outlining a small set of lessons learned and a longer term vision for embedding these efforts into the systems infrastructure.

Community-based treatment outcomes for parents and children exposed to domestic violence

ABSTRACT This study examined treatment outcomes following a 12‐week, community-based group intervention program for children and adults exposed to family violence. The study sample consisted of 106 children between the ages of 3 and 17 (Mu2009=u20098.64, SDu2009=u20093.72) and their nonoffending parent. Participants represented diverse ethnic backgrounds, with most reporting some Asian or Pacific Island heritage. Parents completed the Child Behavior Checklist (Achenbach, 1991) and a measure of parenting skills, and counselors completed rating checklists for children and parents before and after the intervention. Results indicated significant improvement for children and parents. Findings point to the potential effectiveness of such community-based programs with multi-ethnic and Asian and Pacific Island youth exposed to domestic violence and their parents.

Childhood Sibling Aggression and Emotional Difficulties and Aggressive Behavior in Adulthood

Preliminary evidence indicates that childhood sibling aggression, the most common form of family violence, might be associated with aggression and emotional difficulties in adulthood. Three hundred twenty-two adult participants, recruited from various sources, completed an online survey retrospectively examining this relationship further. Levels of childhood sibling aggression perpetration and victimization were highly correlated, precluding separate analyses. Significant associations between childhood sibling aggression and adult emotional difficulties and aggression were found, even after controlling for exposure to other forms of family violence and other demographic variables. Neither gender nor reported sibling relationship moderated the childhood sibling aggression and adult difficulties effects. These findings, while mostly exploratory, suggest that greater attention should be paid to childhood sibling aggression.

Positive and Negative Affect in Clinic-Referred Youth With ADHD

Objective: To examine self-reported positive affect (PA) and negative affect (NA) among youth with ADHD (only and comorbid) and other non-ADHD-referred youth in an ethnically diverse clinical sample. Method: Semi-structured interviews identified 80 pure ADHD, 284 ADHD plus one or more comorbidities, and 730 non-ADHD youth (e.g., other diagnoses or no diagnosis). The Positive and Negative Affect Scale–Children (PANAS-C) was used to assess affective states. Results: Even after controlling for the influence of potential confounds, youth with only ADHD reported higher PA and lower NA than other clinic-referred youth. The ADHD-comorbid group reported higher PA than the “non-ADHD” group, but these groups did not differ on level of NA. ADHD subtype did not influence results. Conclusion: Among clinic-referred youth, ADHD is associated with higher levels of PA and when there are no comorbid disorders, lower levels of NA.

Barriers to Treatment in an Ethnically Diverse Sample of Families Enrolled in a Community-Based Domestic Violence Intervention

Using quantitative and qualitative data, we examined the association between barriers to treatment, motivating factors, treatment attendance, and outcome in a sample of 63 mothers (most of Asian or Pacific Islander descent) enrolled in a family-based domestic violence treatment program. A high number of perceived barriers was associated with lower attendance and lower scores on assessment of parenting practices at posttreatment. Mothers reported relying on their own motivation, observations of childrens improvement, and the quality of their relationships with staff and group members to overcome barriers. A larger number of motivating factors was associated with positive parenting practices at posttreatment. Discussion includes the benefits of a mixed-method approach to measuring barriers and its clinical application to increase treatment participation.

The Effects of Target Attractiveness on Men's Sexual Arousal in Response to Erotic Auditory Stimuli

Abstract Previous research on sexual arousal resulting from auditory stimuli indicates that visual imagery acts as a mediator between stimulus input and resulting arousal. This leads to the question of whether imagery, and subsequent arousal, can be manipulated by providing differing information to hold in semantic memory. This research hypothesizes that attractive images, held within semantic memory and pattern matched with an erotic auditory stimulus, facilitate higher and more rapid self-reported arousal than do unattractive images. Participants in an unattractive condition experienced slower rates and lower mean levels of arousal in response to an auditory stimulus compared with participants in an attractive or no picture condition. No differences existed between groups in maximum arousal scores or the tendency to visualize the target during the listening task. Implications for the role of imagery in sexual response, possible measurement issues, and suggestions for future research are addressed in the discussion.

An Exploratory Factor Analysis of the Knowledge of Evidence-Based Services Questionnaire.

Recent developments for disseminating and implementing evidence-based practices (EBPs) have emphasized the importance of increasing therapists’ knowledge of such techniques. However, systematic efforts to measure knowledge in therapists serving youth have mostly relied on poorly researched study-specific measures. This study investigated the structure of EBP knowledge in a large sample of youth community therapists (Nu2009=u2009240) via a therapist report instrument emphasizing therapeutic commonalities across various types of treatment approaches. Findings supported a three-factor structure of knowledge with scores on factors varying by therapists’ primary practice setting and education level. The relationships between therapist knowledge of and attitudes towards EBPs are also discussed.

Assessing Stability between Treatment Planning Documents in a System of Care

Two studies were performed to examine the presence and stability of specific recommendations for treatment practices in a system of care. Study 1 evaluated the reliability of an instrument designed to quantify specific elements of treatment planning documents. Study 2 used reliably coded data from Study 1 to assess stability of treatment practices and targets across the treatment planning process. This study indicated a generally low level of agreement of between documents, with many specific recommendations being dropped between stages of planning. The implications of these findings and the potential for future research are discussed.

Children's Exposure to Violence by Various Family Members Living in the Home

A sample of ethnically diverse college students reported on household family violence occurring when they were between the ages of 8 and 17. Parents and siblings were reported to engage in violent acts at a similar rate significantly higher than that of other relatives living in the home. Rates of violence exposure showed a small but statistically significant increase when other relatives in the home were included. Within families, there was a strong positive association between amount of violence committed by parents and siblings, verbal and physical violence, and direct and indirect violence. This study provides an innovative method for family violence data collection and points to the importance of including all household members in family violence estimates.