Homeless youths and HIV infection.

Risk of human immunodeficiency virus (HIV) infection exacerbates the already difficult lives of 1.5 million homeless adolescents in the United States. Homeless youths engage in sexual and substance-abuse behaviors that place them at increased risk of contracting HIV, and they demonstrate other problem behaviors that reduce their coping responses. Model HIV prevention programs and interventions for HIV-positive youths, implemented for homeless adolescents, need to be disseminated on a national level. Social policies must recognize adolescents' rights to satisfaction of basic survival needs; comprehensively address the needs of dysfunctional, disenfranchised, and single-parent families; and provide continuity of care for adolescents to facilitate independent living. Special provisions must be made when designing programs for gay, sexually abused, and substance-abusing youths.     

Patterns and correlates of gun ownership among nonmetropolitan and rural middle school students

Examined prevalence of gun ownership and the links among gun ownership, reasons for gun ownership, and antisocial behavior in a sample of nonmetropolitan and rural middle school students. Participants completed the Questionnaire for Students (Olweus, 1995) and included 6,263 students from 36 elementary and middle schools, of whom most were African American (range = 46%-95% per school). Reasons for gun ownership were strongly associated with rates of antisocial behavior. Youths who owned guns for sporting reasons reported rates of antisocial behavior that were only slightly higher than those reported by youths who did not own guns. Youths who owned guns to gain respect or to frighten others reported extremely high rates of antisocial behavior. These high-risk adolescent gun owners were likely to come from families of high-risk gun owners, associate with friends who were high-risk gun owners, and engage in high rates of bullying behavior. Findings suggest that effective violence prevention programs must target high-risk youths, address risk factors that go beyond individual settings, and address a comprehensive array of risk factors.     

Ethical Issues in HIV/STD Prevention Research With High Risk Youth: Providing Help,Preserving Validity

Many preventive intervention studies with adolescents address high-risk behaviors such as drug and alcohol use, and unprotected sex. Randomized controlled trials (RCT) are the gold standard methodology used to test the effectiveness of these behavioral interventions. Interventions outside the rigidly described protocol are prohibited. However, there are ethical challenges to implementing inflexible intervention protocols, especially when the target population is young, experiences many stressful events, and lives in a resource-poor environment. Teens who are at high risk for substance use or sexual risk behaviors tend to be at risk for other problems such as exposure to violence, sexual and physical abuse, depression, and homelessness. How should investigators deal with the psychological and social needs of teenagers in prevention programs in an ethically appropriate way and at the same time preserve the validity of RCT results? We have identified program characteristics, participant characteristics, interaction with parents, and problems with adolescents not in the study as sources of ethical dilemmas in RCT with at-risk adolescents. As a result of our experience, we recommend that every behavioral intervention study develop an ethics protocol, which should include rules for providing help to participants, has contact information for experts to provide guidance, and an emergency procedure for dealing with life threatening situations. In addition, studies should have a resource manual, train research staff in these ethical issues, and work with a data safety and monitoring board or ethics committee.     

Suicide Attempt Risk in Youths: Utility of the Harkavy–Asnis Suicide Scale for Monitoring Risk Levels

The Harkavy–Asnis Suicide Scale (HASS), one of the few self‐report scales assessing suicidal behavior was evaluated and ideation, was evaluated and predictors of suicide attempts (SAs) were identified with the goal of developing a model that clinicians can use for monitoring SA risk. Participants were 131 pediatric emergency department (ED) patients with suicidal behavior. The HASS and Diagnostic Interview Schedule for Children (DISC‐IV) were administered approximately 2 months after ED presentation. When compared with DISC‐IV ratings, sensitivity of the HASS SA items was excellent (100%), and overall classification accuracy was 72%. SA planning was the strongest predictor of SAs.     

Suicide Prevention in an Educational Context: Broad and Narrow Foci

This paper reviews the needs and conceptual bases of school-based youth suicide prevention programs, summarizes their current status, and recommends objectives, processes, and evaluation strategies for focused educational programs in this area. In addition, a broad systemic approach is called for that reorganizes the school context to increase students' contributions to and involvement with the educational process. Such approaches appear to have been effective with a variety of youth deviant behaviors such as dropout and delinquency, and seem to be particularly appropriate to suicidal behavior that is characterized by alienation and withdrawal from social supports. A combination of these broad and narrow foci may be necessary to address suicidal behavior in the educational context.     

Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: Evaluation of Caller Risk Profiles and Interventions Implemented

Crisis lines are settings where identifying individuals at imminent risk of suicidal behavior and intervening to keep them safe are critical activities. We examined clinical characteristics of crisis callers assessed by telephone crisis helpers as being at imminent risk of suicide, and the interventions implemented with these callers. Data were derived from 491 call reports completed by 132 helpers at eight crisis centers in the National Suicide Prevention Lifeline network. Helpers actively engaged the callers in collaborating to keep themselves safe on 76.4% of calls and sent emergency services without the callers' collaboration on 24.6% of calls. Four different profiles of imminent risk calls emerged. Caller profiles and some helper characteristics were associated with intervention type. Our findings provide a first step toward an empirical formulation of imminent risk warning signs and recommended interventions.     

Research in Emergency and Critical Care Settings: Debates,Obstacles and Solutions

Research is an integral part of evidence-based practice in the emergency department and critical care unit that improves patient management. It is important to understand the need and major obstacles for conducting research in emergency settings. Herein, we review the literature for the obligations, ethics and major implications of emergency research and the associated limiting factors influencing research activities in critical care and emergency settings. We reviewed research engines such as PubMed, MEDLINE, and EMBASE for the last two decades using the key words “emergency department”, “critical care”, “research”, “consent”, and “ethics” as the search terms. Research within emergency settings is slow or non-existent due to time and financial constraints as well as the lack of a research tradition. There are several barriers to conducting research studies in emergency situations such as who, what, when, and how to obtain patient consent. The emergency environment is highly pressurized, emotional, and overburdened. The time taken for research is a particular risk that could delay the desired immediate interventions. Ethical issues abound, particularly relating to informed consent. Research in emergency settings is still in its infancy. Thus, there is a strong need for extensive research in the emergency setting through community awareness, resource management, ethics, collaborations, capacity building, and the development of a research interest for the improvement of patient care and outcomes. We need to establish a well-structured plan to assess and track the decision-making capacity, consider a multistep enrolment and consent strategy, and develop an integrated approach for recruitment into studies.     

An Economic Evaluation of the Garrett Lee Smith Memorial Suicide Prevention Program

For more than a decade, the Garrett Lee Smith Youth Suicide Prevention Program has provided funding for community‐based suicide prevention programs to states, tribes, and colleges across the United States. Recent studies provided evidence of the program's effectiveness in reducing suicide mortality and suicide attempts among youth. This study compares the cost of implementing the program with the estimated savings resulting from avoided hospitalization and emergency department visits associated with the averted suicide attempts. The findings suggest that the cost of implementing multifaceted community‐based suicide prevention strategies may be more than outweighed by savings in the health sector.     

A University-Sponsored Career Development Center for Nonstudents

As colleges and universities grow increasingly more responsive to the communities in which they reside, programs are required that address the needs of the nonstudent. Georgia State University's program for nonstudents is reviewed after 5 years of operation, and recommendations are made for adapting it to other settings.     

Risk Factors for Suicide and Suicidal Behavior Relevant to Emergency Health Care Settings: A Systematic Review of Post‐2007 Reviews

Suicide is a global public health problem, and with recent economic and societal changes, there may be emerging risk factors unrecognized by health care professionals. The aim of this systematic review was to update existing suicide risk factor literature applicable to emergency health care settings. A total of 35 articles identified from PsycINFO, CINAHL, and Medline met the inclusion criteria. Results supported the significance of existing suicide risk factors and identified emerging risk factors. The review provides a high‐quality update of risk factor literature that could be applied to emergency health care settings; however, further research is needed to confirm emerging risk factors.     

Identifying and Referring Youths at Risk for Suicide Following Participation in School‐Based Gatekeeper Training

Gatekeeper training is a core strategy of the Garrett Lee Smith Memorial Suicide Prevention Act of 2004. Using data gathered from school‐based gatekeeper trainings implemented by GLS grantees, this analysis examines training and gatekeeper factors associated with (1) identification and referral patterns and (2) services at‐risk youths receive. Time spent interacting with youths was positively correlated with the number of gatekeeper identifications and knowledge about service receipt. Gatekeepers who participated in longer trainings identified proportionately more at‐risk youths than participants in shorter trainings. Most gatekeeper trainees referred the identified youths to services regardless of training type.     

The role of early care and education in addressing early childhood trauma

Young children's experience of trauma is associated with a wide range of adverse events and circumstances, including abuse and neglect, domestic violence, loss of a parent, and community violence. Policymakers and practitioners are increasingly aware that trauma during the first few years of life is especially widespread, and there is growing interest in new ways to support these young children and their families. Many young children who experience trauma attend early care and education (ECE) programs, and these settings offer important opportunities to promote their well‐being. This paper examines strategies currently being implemented in ECE to address early childhood trauma. The paper first examines research on how trauma affects young children's development, ECE environments, and society. We then describe the unique needs of young, traumatized children and features of trauma‐informed care that can address their needs, along with emerging interventions and supports that can be incorporated into or linked with ECE settings as part of a trauma‐informed approach. We conclude with a discussion of future directions for ECE and trauma research, policy, and practice, bearing in mind both the promise of new approaches and a limited evidence base to date.     

The Relationship Between Peer Status and Depressive Symptoms in Children and Adolescents

The purpose of this study was to examine the relationship between specific symptoms of depression and particular styles of peer difficulties. Participants were 1687 students in fourth, sixth, seventh, eighth, ninth, and eleventh grades from a midsized Midwestern city. Based on previous studies, it was hypothesized that rejected and neglected youths would report greater depressive symptomatology than other peers. In addition, aggressive-rejected youth were predicted to report more Interpersonal Problems while submissive-rejected youths were expected to report more Anhedonia. There were no sociometric group differences on global scores of depression as measured by the Children's Depression Inventory; however, the aggressive- and submissive-rejected youths did report specific differences. Aggressive-rejected youths reported more Interpersonal Problems and feelings of Ineffectiveness, while the neglected and submissive-rejected youths reported more Anhedonia. Taken together, such differences provide support for differentiating among types of rejected students and suggest that different interventions may be necessary to address the needs of these youths.     

Predictors and Outcomes of Psychiatric Hospitalization in Youth Presenting to the Emergency Department with Suicidality

Youth suicide attempters presenting to the emergency department (ED) are frequently admitted to psychiatric inpatient hospitals, yet little is known about how clinicians decide which youths to admit versus discharge to outpatient care. We examine predictors of inpatient hospitalization and describe service use outcomes associated with hospitalization in 181 youths drawn from consecutive ED admissions for suicidality. Predictors of hospitalization include ED site, suicide plan, and parent report of problems. Hospitalization was associated with improved linkage to outpatient treatment and more intensive service use. Future research is needed to understand the best service delivery and treatments for these high‐risk youth.     

Young Offenders with Disabilities: Legal Requirements and Reform Considerations

Delinquency rates have been a persistent concern in the United States with juveniles involved in almost a third of arrests for major crimes in 1993. Further, a disproportionate number of youths incarcerated have a disability. Because youths with disabilities in correctional facilities present legal and educational challenges, we explored the parameters of providing appropriate services based on individual needs. Despite applicable federal legislation, the juvenile correctional system often fails to meet the educational needs of those with disabilities (i.e., some youths are denied special education services, services are often inferior to those provided by public schools, and teachers are often inadequately trained). According to federal legislation, juvenile facilities must observe procedural safeguards afforded to those individuals and provide needed services even for pre trial detainees (services, however, may be balanced against legitimate security concerns). Ultimately, state educational agencies have the responsibility for ensuring that youths with disabilities receive a free appropriate education. Promising practices applicable to all youths may include Positive Peer Culture, aggression replacement training, aftercare programs, and research validated instructional interventions.     

Mental Health Services Preparing for the Psychological Consequences of Terrorism

Summary

The Israeli population has been subjected to the stresses of war and terrorist attacks since long before the state was founded. Confronting this extensive experience of terrorism-related psychological trauma, the Mental Health Services of the Ministry of Health designed and implemented a comprehensive emergency response system that operates in general hospitals and community settings to meet the psychological needs resulting from terrorism at both the individual and the population levels. This article describes general premises, basic elements, administrative structure and functioning of this system, as well as training programs for various service providers working with the victims.     

Clinical Geropsychology: Implications for Practice in Medical Settings

Older adults are a rapidly growing segment of the population, who have high rates of chronic illness and who utilize health care resources heavily. Psychologists must become better prepared to work with older patients in geriatric settings, including geriatric assessment units, memory disorders clinics, and nursing homes. In addition, all psychologists will increasingly encounter older patients in environments such as primary care clinics, rehabilitation settings, and disease management programs focusing on problems that are prevalent in older patients (e.g., cancer, diabetes). Suggestions are offered for adaptation of usual clinical practice to address the special needs of older patients and their families, and recommendations made for advancing and expanding the practice of clinical geropsychology.     

Assessing and Managing Risk With Suicidal Individuals

The University of Washington Risk Assessment Protocol (UWRAP) and Risk Assessment and Management Protocol (UWRAMP) have been used in numerous clinical trials treating high-risk suicidal individuals over several years. These protocols structure assessors and treatment providers to provide a thorough suicide risk assessment, review standards of care recommendations for action, and allow for subsequent documentation of information gathered and actions taken. As such, it is a resource for providers treating high-risk populations across multiple contexts (e.g., primary care, outpatient psychotherapy, emergency department). This article describes both the UWRAP and UWRAMP. Taken together, these assessment and risk management tools include (a) assessment questions for gathering information to determine the level of risk, (b) action steps that can be taken to ensure safety, and (c) a companion therapist note where providers document their assessment and actions.     

In- and out-of-school peer groups of immigrant youths

Multiethnic societies typically aim to have immigrant and native youths mix and be friends, preferably in all contexts in which they spend time. Schools and neighbourhoods are the two settings where youths spend the most time with peers during adolescence. The present study explored the in- and out-of-school peer groups of 174 immigrant junior high school pupils (Mean age = 14.39) who attended an integrated school but lived in a segregated neighbourhood. A person-oriented approach was used and cluster analyses were conducted both within and across the two settings. The results show that youths mostly have the same kind of friendship formations in both settings, regardless of the ethnic composition of each setting. In terms of adaptation, the results consistently show that for boys, having only immigrant friends is related to problematic adaptation in both settings. No relationship between peer formations and adaptation was found for girls. The study highlights the importance of considering gender and viewing youths as embedded in systems of multiple settings, in order to achieve true integration.