Applying Utilization Management Principles to a Comprehensive Service System for Children with Emotional and Behavioral Disorders and Their Families: A Feasibility Study

The Comprehensive Services Act for At Risk Youth and Families of Virginia (CSA), is a service, funding, and organizational reform initiative designed to improve the provision of child centered and family focused services within a community setting. We conducted this study in order to assess the feasibility of applying utilization management principles to the CSA in order to improve the appropriateness, quality, and cost effectiveness of this service delivery system. Data were gathered through focus groups, surveys, clinical profiling, and analysis of costs, and service utilization. While overall program costs increased since inception of the program, the costs per child served rose less than the rate of inflation. CSA appeared to be serving children with a high degree of emotional and behavioral difficulties. There was considerable variation among localities in placement patterns. A majority of survey and focus group respondents were willing to consider the application of utilization management principles to the CSA as long as decision making remained within localities. We concluded that there is a constructive role for utilization management approaches to improve the appropriateness and quality of services as well as enhancing efficiency in child mental health.     

Toward a New Paradigm for Multicultural Counseling

Wisdom is introduced as a fundamental quality of the effective multicultural counselor. Wisdom is defined, discussed, and differentiated from intelligence. The authors propose that to be an effective multicultural counselor requires more than textbook knowledge. Wisdom, as a transcultural concept, is considered in relation to culture, context, dialectical thinking, awareness, metacognition, deep interpersonal insight, and advanced empathy. Implications for counselor education and professional practice are discussed. Wisdom is an ancient subject that may provide a “new” paradigm with the potential to bring the field to a higher plateau of effectiveness in practice and training.     

Context-processing deficits in schizophrenia: converging evidence from three theoretically motivated cognitive tasks

To test the hypothesis that the ability to actively represent and maintain context information in a central function of working memory and that a disturbance in this function contributes to cognitive deficits in schizophrenia, the authors modified 3 tasks--the AX version of the Continuous Performance Test, Stroop, and a lexical disambiguation task--and administered them to patients with schizophrenia as well as to depressed and healthy controls. The results suggest an accentuation of deficits in patients with schizophrenia in context-sensitive conditions and cross-task correlations of performance in these conditions. However, the results do not definitively eliminate the possibility of a generalized deficit. The significance of these findings is discussed with regard to the specificity of deficits in schizophrenia and the hypothesis concerning the neural and cognitive mechanisms that underlie these deficits.     

The development and predictive relations of play and language across the second year.

The play and language development of 171 toddlers was examined at 14 and 18 months by observing their activities on the Symbolic Play Test and by assessing their language skills using the MacArthur Communicative Development Inventories (MCDI) and the Reynell Developmental Language Scales. Additionally, data from the Bayley Scales of Infant Development and the MCDI were obtained at 24 months, in order to investigate how play and language measures taken at 14 and 18 months predict children's development at the age of 2 years. The results showed that the vocabulary production and symbolic play of the 14-month-old toddlers made a unique contribution to their language and cognitive skills at the age of 2 years, while at 18 months only language variables made a similar contribution. Other-directed pretense discriminated between the children's subsequent language and cognitive skills best, whereas nonsymbolic play had no independent predictive contribution. Significant gender differences were found in the use of nonsymbolic and symbolic play acts already at 14 months. Gender did not, however, contribute to the prediction of the children's subsequent skills, whereas maternal education significantly added to the prediction of the 2-year-olds' maximum sentence length and that of their cognitive development.     

Common and Unique Factors Associated with DSM-IV-TR Internalizing Disorders in Children

With the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association. Diagnostic and statistical manual of mental disorders DSM-IV Fourth Edition-Text Revision. Author, Washington, DC. 2000) ahead, decisions will be made about the future of taxonomic conceptualizations. This study examined the factor structure of items from three internalizing disorders (Social Phobia, Generalized Anxiety Disorder, and Depression) on the Anxiety Disorders Interview Schedule for DSM-IV-Child Version (Silverman, W. K., & Albano, A. M. Anxiety disorders interview schedule for children for DSM-IV, child and parent versions. Psychological Corporation, San Antonio, 1996). Two-, three-, and four-factor models emerged in an exploratory factor analysis. Confirmatory factor analysis provided additional empirical support for the four-factor model over the two- or three-factor models. Implications for the structure of the DSM-V taxonomy in children and adolescents are discussed.     

Effects of weight cycling on metabolic control in male outpatients with non-insulin-dependent diabetes mellitus

Examined the effects of weight cycling (i.e., losing and regaining or gaining and relosing body weight) versus weight maintenance on metabolic control in 327 adult, male, outpatient veterans with non-insulin-dependent diabetes mellitus (NIDDM) who were followed over an average of 3.4 years. When compared with weight maintenance, weight cycling, whether defined as a categorical or as a continuous variable, was not found to be associated with deficits in metabolic control or increased need for hypoglycemic medication. Patients who weight cycled had fasting serum glucose and hemoglobin A1c levels comparable to those who remained within 10% of their initial body weights, and these levels of metabolic control were obtained with similar classes and dosages of hypoglycemic medication.