Evaluating wraparound services for seriously emotionally disturbed youth: pilot study outcomes in Georgia

Since the early 1990s, intervention strategies designed to preserve the family system while serving children diagnosed with severe emotional disturbances (SED) have been on the rise. Many of these strategies sought to provide families with comprehensive approaches that link various agencies and services, thus providing a complete system of care. The term wraparound services was coined to describe these approaches. However, evaluation studies of the outcomes of these programs remains limited. In order to assess the impact of wraparound services, outcome evaluation programs need to be implemented and their feasibility assessed. This paper focuses on the feasibility and implementation of a computer-based field assessment system and the ability to provide empirically based feedback to the programs. In addition, an assessment of 15 participating children and families, comparing selected aspects of clinical functioning at intake and 6-month follow-up, is presented and discussed.     

Characteristics of seriously emotionally disturbed youth with and without substance abuse in intensive case management

Youth with emotional disturbance who have substance abuse problems are of particular concern to child-serving agencies. Approximately 22% of the youth served in New York State's Intensive Case Management Program for Children and Youth (CYICM) have identified substance abuse problems. We compared youths enrolled in CYICM who abuse substances with those who do not abuse substances. Adolescents with substance abuse problems differed from non-abusing adolescents. The abusing cohort was most likely to be emancipated minors, not enrolled in school, less likely to be members of a minority group, and more likely to have private health care coverage. They also evidenced a different constellation of symptoms than the non-abusing cohort, with abusers tending to display suicidal symptoms and behaviors and sexual acting out. Abusers were also more likely to have been admitted to private psychiatric hospitals and to have had crisis contacts in emergency rooms. Similar to non-abusers, however, abusers spent significantly fewer days as inpatients in state hospitals, and had fewer admissions to these hospitals following their enrollment in CYICM.     

Self-image of emotionally disturbed adolescents

This study examined the ways in which normal, depressed, and conduct-disordered adolescents differ with regard to self-image. Normal and psychiatrically hospitalized adolescents completed the Offer Self Image Questionnaire for Adolescents (OSIQ). Patients were grouped on the basis of their DSM-III diagnoses, and their OSIQ scores were compared. Major depressive disorder, particularly the first episode, was associated with poor self-evaluation in multiple areas, while conduct disorder was associated with almost no specific self-image deficits. For younger (12- to 15-year-old) adolescents, a repeated episode of depression was associated with a poorer selfimage than was a diagnosis of dysthymic disorder or a typical depression, but a better self-image than a single episode of depression, suggesting that at this age, repeated episodes are met with internal adaptation rather than continued self-devaluation. Adolescents who received a diagnosis of both conduct disorder and major depression reported an overall level of self-image disturbance between those with either of these disorders alone, suggesting that acting-out behaviors may attenuate the self-devaluing experience of depression. Results are discussed in terms of current issues in adolescent development and developmental psychopathology.Portions of this article were presented at the annual meeting of the Midwestern Psychological Association, Chicago, 1986, and the annual meeting of the Association for the Advancement of Behavior Therapy, Chicago, 1986. The author wishes to express her appreciation to Kenneth I. Howard for his continued guidance throughout this project; to Lauren B. Alloy, Richard R. Bootzin, G. Daniel Lassiter, William Revelle, and two anonymous reviewers for helpful comments on an earlier draft; to Daniel Offer and Eric Ostrov for allowing use of their normative data; and to the staff of Charter Barclay and Riveredge Hospitals for their assistance in the data collection.     

A prevocational training project for emotionally disturbed adolescents

Adult inpatient populations, trained to develop a repertoire of work-related skills such as tracking and following directions, utilizing emotional controls, relating to the world in a realistic manner, as well as acceptance of supervision, grooming, punctuality, and attendance. These skills eased their transition to the community and assisted in a more positive existence once within that community as compared to their untrained cohort. Additionally, the process of vocational training has been demonstrated to have therapeutic benefits. This project used many of the same adult training principles but applied them to an adolescent inpatient population. A vocational training project using specific behavioral interventions resulted in comparable improvement for adolescent subjects otherwise evidenced in adult patients' work-related skills and abilities. This training project was conducted yearly, 32 h per week for 10 weeks for 4 years. The project combined actual work experience, classroom time and behavioral interventions and rewards. A 16 × 10 analysis of variance was computed to assess improvement in work-related skills and abilities. The analysis yielded and F = 2.57, p < 0.01, suggesting the efficacy of the behavioral interventions when applied to adolescent inpatient populations. © 1997 John Wiley & Sons, Ltd.     

The emotionally disturbed child: Disturbed or disturbing

The notion that a child's behavior may be more disturbing than disturbed has been of interest to educators of behaviorally deviant children. Behavior indicative of deviance in children was studied with respect to the relative degree of disturbingness which each was judged to reflect. Four factor dimensions of disturbingness were identified and discussed with regard to future research and educational implications.The author wishes to thank Richard Gibson, John Salvia, and James Ysseldyke for their assistance in obtaining portions of the data represented here. A grateful acknowledgment is offered to Ron Eaves, Dave Herr, and John Salvia for their creative contributions.     

Development and training of role-taking abilities with emotionally disturbed preschoolers: A pilot study

The purposes of the present study were to verify whether emotionally disturbed preschoolers admitted to a medical day-care center would evidence a developmental lag in role-taking skills as compared to nondisturbed kindergartners and to study the effects of a training program with as its purpose to teach the MDC children to deal with their own and others' emotions. Forty-three children from a kindergarten (n=22; mean age of 4.11 years) and a medical day-care center (n=21; mean age of 4.11 years) participated in this study. The MDC children were randomly assigned to a control (n=9) and to a training condition (n=12). The training for the latter group covered a 10-week period. The results from this pretest and posttest design revealed no differences in performance for emotional role-taking (i.e., Borke-task) and social guessing (i.e., De Vries-task) between the disturbed and nondisturbed children on the pretest. On the posttest, however, a significant developmental lag was evident for the MDC-children who did not receive the training and those who did and the control group.     

Reflection-impulsivity and academic attainment in emotionally disturbed children

Sixty-five emotionally disturbed children were administered the Matching Familiar Figures Test (MFF) and standard achievement tests. Significant correlations were obtained between MFF errors and achievement and Mental Age (MA) but not between MFF latencies and achievement and MA. Fifteen impulsive and fifteen reflective children, matched on MA and not differing on Chronological Age (CA), did not differ on their levels of academic achievement. However, the reflective group was found to be two grades above the impulsive group in actual grade placement. Results are discussed in terms of possible behavioral differences and their consequences for the individual.     

Reflection-impulsivity and information seeking in emotionally disturbed children

Forty-four emotionally disturbed children were administered the Matching Familiar Figures Test by one examiner after which the 13 most impulsive and 13 most reflective were chosen. A second examiner administered the Fixed Alternatives Question-Asking Game in whichSs sought information by asking questions that could be answered either yes or no. These questions were classified on a developmental basis; reflective children were found to employ more mature questions than did impulsive ones. Indirect comparisons between the present results and those obtained with normalSs were made.     

Improving same-sex and heterosocial interactions of emotionally disturbed adolescents

This study attempted to increase the occurrence of sexual-social interactions of emotionally disturbed adolescents. Two males' and two females' sexual-social interactions were analyzed within a special eduction classroom. An extension of a reversal design (baseline/individual) contingency and response cost/group contingency /individual contingency and response cost ) was used to assess treatment effects on same-sex and heterosocial interactions. In addition, the group contingency condition was staggered in a multiple baseline fachion across the two response classes. The results indicate that, regardless of sex, group contingencies are more effective than individual contingencies in increasing positive sexual-social interactions. More important, it was inferred from the results that emotionally disturbed adolescents' social interactions represent difficulties of performance rather than competence.     

Anxiety and locus of conflict in emotionally disturbed children

The State Trait Anxiety Inventory for Children (STAIC) and the Children's Manifest Anxiety Scale (CMAS) were administered to 50 emotionally disturbed children (40 males and 10 females). In addition, ratings on a Locus of Conflict Rating Scale were obtained from their special education teachers. Significant correlations were obtained between all anxiety measures. However, anxiety, as measured by the CMAS, A State and A Trait, was not significantly correlated with the ratings of internalization, externalization, or the total maladjustment index. Girls reported greater anxiety than boys on the CMAS and the STAIC A Trait scale, while boys were rated as significantly higher on the internalization and externalization scales, and in total maladjustment.     

Reliability of state-trait anxiety with emotionally disturbed children

The test-retest reliability and the internal consistency of the State-Trait Anxiety Inventory for Children (STAIC) was determined for 30 emotionally disturbed children. The STAIC was administered at the beginning and end of a three month period. Test-retest reliability for the STAIC A-State and A-Trait scale were. 63 and 44, respectively. Alpha values of internal consistency were 89 and 88. Differences in these results and findings previously reported by Spielberger (1973) are discussed in terms of population differences.     

Adaptive behavior in young children of emotionally disturbed women

Children of mentally-ill parents are population at increased risk for psychiatric disorder, and recent research has focused on the psychological development of these individuals. The Rochester Adaptive Behavior Inventory (RABI) was developed to measure the adaptive behavior of such high-risk children based upon a parental interview. Scales defining specific behavior spheres were reproduced in four samples of 30- and 48-month-olds. These scales differentiated high-risk children along dimensions of maternal psychopathology and social status. Global measures of maternal illness, such as severity of symptoms, proved to be more powerful than specific diagnosis. Race and socio-economic status also had a major impact on adaptive behavior. Implications of the data for high-risk theories of schizophrenia are discussed.