David G. Stewart

Effectiveness of a Dialectical Behaviour Therapy Program for Incarcerated Female Juvenile Offenders

Background: Female offenders incarcerated in Washington State have demonstrated higher rates of mental health needs than boys. Linehan’s (1993a, b) Dialectical Behavioural Therapy (DBT) is an effective treatment for adult women with Borderline Personality Disorder. DBT utilises a combination of skills training, problem solving, and validation to enable patients to reduce self-destructive, impulsive and aggressive behaviours. The prevalence of similar emotional problems among female juvenile offenders suggests that DBT may be an effective strategy for this population. The State of Washington Governor’s Juvenile Justice Advisory Committee sponsored a collaborative project conducted by a research team from the University of Washington and the staff at the Juvenile Rehabilitation Administration’s Echo Glen Children’s Center to evaluate the effectiveness of a DBT intervention. Method: Pre-post intervention records were compared for female offenders from a mental health and a general population unit where DBT was implemented. Youth on a third unit served as a comparison group. Youth behaviour problems, staff punitive responses were compared before and after the intervention period. Results: Youth behaviour problems and use of punitive responses by staff decreased compared to the year prior on one cottage (unit) while no behaviour or staff changes were noted on another. Conclusions: The evaluation demonstrated the efficacy of providing DBT to female offenders in a residential setting and yielded mixed results on behaviour change during the study period that may relate to quality of training and prior youth behaviour problems.

Universal Emotional Health Screening at the Middle School Transition

This article describes the implementation of the Developmental Pathways Screening Program (DPSP) and an evaluation of program feasibility, acceptability, and yield. Using the Mood and Feelings Questionnaire (MFQ) and externalizing questions from the Youth Self Report (YSR;Achenbach, 2001), universal classroom-based emotional health screening was implemented with students as they began middle school. Of all sixth graders enrolled in four participating Seattle schools, 861 (83%) were screened. Students who screened positive for emotional distress (15% of students screened) received onsite structured clinical evaluations with childrens mental health professionals. Seventy-one percent of students who were evaluated were found to be experiencing significant emotional distress, with 59% warranting referral to academic tutoring, school counselor, and/or community mental health services. Successful implementation of in-class screening was facilitated by strong collaboration between DPSP and school staff. Limitations of emotional health screening and the DPSP are discussed, and future steps are outlined.

Using the Short Mood and Feelings Questionnaire to Detect Depression in Detained Adolescents.

The Mood and Feelings Questionnaire (MFQ) is examined for its utility in screening youth in juvenile justice settings for depression. In a cross-sectional study conducted at King County Juvenile Detention Center, a representative sample of 228 detained adolescents complete structured assessments, including the MFQ and the Massachusetts Youth Screening Instrument. Fifty youth also complete the Voice-Diagnostic Interview Schedule for Children. Internal reliability coefficient for the MFQ short form (SMFQ) is = .87. Factor analysis produces a unifactorial scale with item loadings of .43 to .78. At SMFQ cutoff 10, sensitivity and specificity are optimized at 1.00/0.79. Prevalence of major depressive disorder is estimated at 32.1% (95% Confidence Interval = 25.3% to 39.2%). The SMFQ shows potential for depression screening of detained adolescents.

Predictors of Mental Health Service Enrollment Among Juvenile Offenders

The objective was to identify predictors of public mental health service enrollment among detained juvenile offenders. A representative sample of 228 juvenile detainees was interviewed with measures of psychological symptoms and impairment, associated risk factors, and demographic variables. Logistic regression analyses determined how the 110 youth enrolled in mental health services differed from the 118 youth not enrolled. Main effects were found for age, gender, and number of prior detention stays such that younger offenders, female offenders, and recidivists were more likely to have received mental health services. Mental health status, level of functioning, and frequency of substance use were not related to service enrollment. Race interacted with mental health symptoms and recidivism such that Caucasians with greater numbers of symptom elevations and prior detention stays were more likely to be enrolled in mental health services, whereas symptom elevations and recidivism were not related to service enrollment among African American offenders. Systematic assessment and referral procedures may be a necessary step toward improving the likelihood that mental health services are distributed to juvenile offenders on the basis of mental health need.

The indirect effect of somatic complaints on report of posttraumatic psychological symptomatology among Somali refugees.

Somali refugees are a growing population of displaced persons at risk for considerable traumatic exposure and its subsequent psychological symptomatology. Two hypotheses were proposed to evaluate the relationships between somatic complaints and posttraumatic psychological symptoms in a community-based sample of 74 adult Somali participants. As hypothesized, traumatic exposure predicted increased symptoms of posttraumatic stress disorder (PTSD; r = .64, p < .01), depression (r = .31, p < .01), and anxiety (r = .38, p < .01) in the basal model. In evaluation of the second hypothesis, somatic complaints were found to have a statistically significant indirect effect on the predictive relationship between traumatic life events and mood disturbance, accounting for 9% of the variance in depression and 14% of the variance in anxiety. However, somatic complaints failed to have an indirect effect on the relationship between traumatic exposure and symptoms of PTSD. Post hoc analyses revealed that, consistent with research conducted with nonrefugee populations, PTSD had a statistically significant indirect effect that accounted for 13% of the variance in the relationship between trauma and somatic complaints. These findings provide preliminary data regarding the influence of somatic complaints on the self-reported psychological symptoms of internationally displaced Somali refugees.

Post-Migration Stress as a Moderator Between Traumatic Exposure and Self-Reported Mental Health Symptoms in a Sample of Somali Refugees

The current study examined the potentially moderating influence of post-migration living difficulties on the relationship between pre-migration traumatic exposure and self-reported symptomatology in a sample of 74 adult Somali refugees residing in the United States. Results suggest that post-migration psychosocial stressors exacerbate depressive symptoms (ΔR 2 = .068, p = .017) for those exposed to low levels of trauma relative to other posttraumatic psychological or somatic difficulties. No moderated effect was found for symptoms of posttraumatic stress disorder, anxiety, or somatic complaints.

Classification of co-occurring depression and substance abuse symptoms predicts suicide attempts in adolescents.

Although both depression and substance use have been found to contribute to suicide attempts, the synergistic impact of these disorders has not been fully explored. Additionally, the impact of subthreshold presentations of these disorders has not been researched. We utilized the Quadrant Model of Classification (a matrix of severity of two disorders) to assess for suicide attempt risk among adolescents. Logistic regression was used to examine the impact of co-occurring disorder classification on suicide risk attempts. Results indicate that quadrant classification had a dramatic impact on suicide attempt risk, with individuals with high severity co-occurring disorders at greatest risk.

Family Integrated Transitions: A Promising Program for Juvenile Offenders with Co-Occurring Disorders.

This study evaluates the impact of the Family Integrated Transitions (FIT) program on juvenile recidivism. FIT is a family-based intervention for youths with co-occurring substance use and mental health disorders transitioning to home from incarceration. We used administrative data to compare 36-month recidivism rates for youths receiving FIT (N = 105) versus usual care (N = 169). Participation in FIT was associated with a 30% reduction in felony recidivism, but not related to overall, violent felony, or misdemeanor recidivism. This study provides cautious evidence for a promising approach toward reducing felony recidivism for youths with co-occurring disorders transitioning out of the juvenile justice system.

Electrophysiologic findings in post-traumatic syringomyelia: implications for clinical management.

Traumatic spinal cord injured (SCI) patients may develop pain, new weakness and/or sensory loss due to an enlarging fluid-filled cyst in the spinal cord. The clinical history and physical exam are nonspecific and insensitive, particularly for diagnosing and monitoring recurrent or progressive post-traumatic syringomyelia (PTS). We compare the sensitivity and specificity of three electrodiagnostic tests, median and ulnar F waves, electromagnetic motor evoked potentials (MEP), and needle electromyography, with respect to syrinx by imaging (MRI or CT scan) and neurologic progression on serial clinical exams. Central motor conduction time (CMCT) calculated from scalp and spine MEP was the most sensitive diagnostic test. F waves were less sensitive and less specific than the CMCT, and did not provide evidence of syrinxes in the mid or upper cervical cord. Positive sharp wave and fibrillation potentials were the least sensitive and least specific. The CMCT is a useful adjunct to imaging studies for diagnosing and monitoring PTS.

Effectiveness of Motivational Incentives for Adolescent Marijuana Users in a School-Based Intervention

PURPOSE This study examined whether adolescents receiving Motivational Interviewing (MI) intervention have different outcomes compared to those receiving Motivational Incentives (Motivational Interviewing combined with Contingency Management; MI+CM). METHOD A total of 136 adolescents (from a parent study of 220 adolescents) with problematic substance use were recruited from 8 high schools in Washington State, where they completed either 8-weeks of MI or MI+CM. Frequency of marijuana use was assessed at baseline, at the end-of-treatment, and at 16-week follow-up. RESULTS A balanced and matched sample was created using propensity scores, then analyzed using Hierarchical Linear Modeling (HLM). Multilevel regression analyses revealed that adolescents who received MI+CM exhibited a greater reduction in use across time (p<.05). Reductions at the end-of-treatment were greater for the MI+CM condition (Cohens d=-.82) compared to MI alone (Cohens d=-.33), but did not differ at 16-week follow-up. Adolescents receiving MI+CM showed significantly fewer negative consequences of marijuana use at the end-of-treatment (t1, 124=2.26, p<.05), higher use of coping strategies (t1, 124=3.01, p<.01), and increased likelihood to attend additional treatment for substance use (χ2 1, 124=4.12 p<.05), though hypothesized improvements in motivation and school attendance were not found. Use of coping strategies at the end-of-treatment had a significant indirect effect on the relationship between the intervention condition and marijuana use at the end-of-treatment (F3, 121=10.20, R2=.20, p<.01). CONCLUSION These results suggest that the inclusion of contingencies into adolescent marijuana treatment decreases the end-of-treatment frequency of marijuana use and related consequences while increasing the use of coping strategies and the pursuit of additional treatment.