Kathleen Kemp

Advance directives in mental health care: evidence, challenges and promise

Psychiatric advance directives (PADs) are written documents or oral statements that allow adults with decision-making capacity to declare their treatment preferences and/or to designate proxy decision makers to act on their behalf should they be deemed incapable in the future of making informed choices on their own. In the U.S., the Patient Self-Determination Act (1) created momentum for recovery-oriented care, which has led to the enactment of mental health-related advance planning legislation in about two-thirds of the states (2,3). Internationally, increasing attention to such tools is found in the U.K., Ireland, Germany, Belgium, Canada, New Zealand, Australia and India.

Advance Directives for Mental Health Care: Innovation in Law, Policy, and Practice

Virginia appears to be the first state to commit itself to statewide implementation of psychiatric advance directives, and its experience may be highly instructive for other states. The project began with consensus building among stakeholders (2007-2009), followed by revisions to Virginias Health Care Decisions Act (2009-2010) and designation of five of the states 40 Community Services Boards as demonstration sites for facilitation efforts. Early implementation efforts quickly showed that psychiatric advance directives are not self-executing innovations. This column describes the early policy and practice innovations, lessons learned from initial implementation efforts, and three approaches to facilitating completion of advance directives by consumers.

Building Consensus on the Characteristics of Developmental Maturity: A Cross-Disciplinary Survey of Psychologists

ABSTRACT A critical step toward ensuring a consistent approach to and communication about the construct of developmental maturity is refinement of a general, unified representation of this construct across psychological subspecialties. The current study evaluated the core characteristics of developmental maturity by examining the factor structure of this broad concept. Results of an exploratory factor analysis supported a four-factor solution of developmental maturity: independent functioning, decision making, emotion regulation, and general cognitive processing. Overall, psychologists across subspecialties did not differ significantly in their ratings of items across the four factors. Findings contribute to a cross-disciplinary, comprehensive, and operational definition of developmental maturity.

Evaluation of Juvenile Competency to Proceed: Applying the Dusky Standard

Despite the general lack of legal guidance in defining the minimum standard for juvenile competency to proceed, such evaluations are frequently requested. Research suggests that younger adolescents are found incompetent at higher rates than adults and may have unique deficits due to their developmental immaturity. Evaluators must consider these potential deficits when applying the Dusky standard to juvenile evaluations, and make reasonable recommendations regarding the likelihood of the achievement of competence if developmental immaturity plays a fundamental role. This case vignette illustrates how to evaluate and consider developmental immaturity when applying the Dusky standard to juvenile competency to proceed.

Emotion Regulation as a Predictor of Juvenile Arrest

The current study examines emotion regulation as a novel dynamic factor of juvenile arrest as it compares with known static and dynamic risk factors. Participants included seventh graders at five urban public schools (N = 420, Mage = 13, 53% male). The predictive relationship between adolescent self-, parent-, and teacher-report of baseline adolescent emotional competence and arrest at 30-month follow-up was assessed. Stepwise logistic regression analyses revealed that teacher report of emotion regulation strategies, minority status, and lifetime marijuana use were significant predictors of arrest. Findings indicate teacher report of emotion regulation competence in early adolescence may be an important consideration for prevention program development.

Depressive Symptoms Moderate Dating Violence Prevention Outcomes Among Adolescent Girls

PURPOSE Few dating violence prevention programs assess how variations in initial violence risk affects responsiveness. This study examines the efficacy of Date SMART, a dating violence and sexual risk prevention program designed to target high-risk adolescent girls, in preventing dating violence in the context of varying initial levels of depressive symptoms. METHOD A diverse sample of N = 109 female adolescents with a history of physical dating violence participated in a randomized controlled trial of the Date SMART program and a knowledge only (KO) comparison. RESULTS Using baseline depression level as a primary risk factor, a series of multilevel models revealed significant main effects of baseline depression such that higher baseline depression was associated with greater physical dating violence perpetration and victimization. Results also showed a three-way interaction for assessment point, depressive symptoms, and condition for physical dating violence perpetration. Specifically, those with higher baseline depression in Date SMART showed significantly less physical dating violence perpetration at follow-ups compared with those with higher baseline depression in the KO group. This difference in violence reduction between conditions was not observed for those with lower baseline depression. DISCUSSION Date SMART appears to effectively reduce physical dating violence perpetration in those with higher levels of initial risk. Current findings support that adolescents with different risk profiles respond differently to violence prevention programs.

Can We Hasten Development? Effects of Treatment on Psychosocial Maturity:

Research continues to highlight factors associated with developmental immaturity, including persistent delinquency. This article examines whether aspects of developmental immaturity, psychosocial maturity, and emotion regulation are responsive to therapeutic intervention. Fifty-seven female youth in secure residential juvenile justice facilities participated in a randomized controlled trial of the Juvenile Justice Anger Management (JJAM) Treatment for Girls, an intervention that targets skills relevant to psychosocial maturity, including problem-solving, coping, and emotion regulation. Participants in JJAM showed increases in temperance, providing evidence that intervention might stimulate psychosocial development. Implications for treatment, evaluation, and measurement of psychosocial maturity are discussed.

Suicidal Ideation and Attempts Among Court-Involved, Nonincarcerated Youth

ABSTRACT Over the past decade, suicide remains one of the leading causes of death among adolescents and a public health priority. Court-involved non-incarcerated juvenile justice youth frequently present with risk factors for suicide. Among these court-involved youth, 14% (n = 50) endorsed a lifetime history of suicidal ideation and attempts. Three main factors were associated with increased risk: prior offense, substance use, and childhood sexual abuse histories. This study highlights the importance of understanding suicidal behavior among nondetained juvenile justice populations. Community-based court involvement provides a rare opportunity to coordinate screening and suicide prevention efforts for youth and their families.

Success in School for Justice-Involved Girls: Do Specific Aspects of Developmental Immaturity Matter?

Abstract Developmental immaturity (DI) may help explain some of the variability in aspects of academic achievement among girls in the juvenile justice system, a population with high rates of truancy, dropout, and school failure. This study examined the relationships among the decision making and independent functioning components of DI, verbal intelligence, and academic achievement within this population. Using data from 60 girls in residential juvenile justice facilities, multiple regression analyses indicated that verbal IQ moderated the relationship between the DI construct of decision making and academic achievement. Self-reported school attendance and number of previous arrests did not significantly mediate the relationship between DI and academic achievement. These results may indicate that the decision-making factor of DI may be particularly important, and, if results are replicated, future intervention efforts could focus more on improving this skill within this juvenile justice population. Additionally, the overall importance of the full DI construct is an important area of future study.