Effectiveness Research in the Context of School-Based Mental Health

There are many challenges to transporting evidence-based treatments from laboratories into real-world settings. However, if we hope to make our evidence-based treatments accessible and available to children and usable by community professionals, effectiveness research is imperative. We argue that schools represent an ideal real world setting in which to conduct such research. The goals of this paper are to present the advantages of conducting effectiveness research in the school setting and to encourage clinical researchers to engage in effectiveness research in this location, as there are benefits to children, pre-service professionals, communities, and researchers. We attempt to further advance the literature by discussing the challenges associated with this work and by providing a case example (The Youth Experiencing Success in School [Y.E.S.S.] Program) that demonstrates real world application of our recommendations.     

Psychosocial Interventions for Children with Early-Onset Bipolar Spectrum Disorder

Once considered virtually nonexistent, bipolar disorder in children has recently received a great deal of attention from mental health professionals and the general public. This paper provides a current review of literature pertaining to the psychosocial treatment of children with early-onset bipolar spectrum disorder (EOBPSD). Commencing with evidence of the emerging interest in this topic, we then focus on terminology, the rationale for studying EOBPSD in children, current research and clinical progress, possible explanations for the recent increase in recognition, and essential issues that form the foundation of effective psychosocial treatment. Next we explore areas of research with direct implications for psychosocial treatment. These include biological and psychosocial risk factors associated with bipolar disorder; and the psychosocial treatment of adult-onset bipolar disorder, childhood-onset unipolar disorder, and anger management in children. Following this, we discuss treatments being developed and tested for children with EOBPSD. Finally, we conclude with recommendations for future studies needed to move the field forward.     

Peer-mediated reinforcement plus prompting as treatment for off-task behavior in children with attention deficit hyperactivity disorder

Functional analyses revealed that peer attention was one variable maintaining the off-task behavior exhibited by 3 students with a diagnosis of attention deficit hyperactivity disorder (ADHD). Peer-mediated reinforcement plus prompting was then used to reduce off-task behavior in a simulated classroom environment. Implications for future applications of this procedure with children diagnosed with ADHD are discussed.     

Commentary on the Multimodal Treatment Study of Children with ADHD

The multimodal treatment study of attention deficit hyperactivity disorder (MTA Study) constitutes a landmark in the history of treatment research in child psychopathology, being the largest single study of its kind ever undertaken. Important findings have emerged from this project, as the papers in the present volume will attest. This commentary focuses on several concerns about the assumptions that appear to have guided the design of the MTA study, particularly its psychosocial treatment component, as well as the manner in which treatment results have been presented to date. In particular, no explicit theory of ADHD appears to have guided the construction of the treatment components, relying instead on implicit theories associated with those treatments, such as the notion that the symptoms of ADHD arise through faulty learning and defective contingencies of reinforcement. Future articles from this study will need to address these and other concerns if the results of the study are to be properly interpreted and the scientific and clinical yield is to be maximized.     

放弃治疗面面观

放弃治疗有广义和狭义两种概念,根据临床实践分为主动放弃和被动放弃、单方放弃和双方放弃、明示放弃和暗示放弃、完全放弃和部分放弃。有许多的放弃治疗从患者本人、亲属、医务人员和医疗付费等方面考虑都有积极的意义。在医学伦理学中放弃治疗一直是一个有争议的问题,其道德意义在于体现了唯物主义观点,对人生命的尊重和社会公益原则。对其立法问题有待解决。     

乙型肝炎防治中值得医患共同注意的几个问题

乙型肝炎在我国人群中广泛存在,到目前为止,还没有特效的治疗方法和药物。由于乙型肝炎易慢性化,直接威胁患者的健康,,对社会及个人造成的影响已引起各界关注。今就乙型肝炎的诊断。治疗以及自保健,如何正确对待等方面问题从医学伦理的角度进行分析以供医患参考。     

Exercise Dependence: Diagnostic and Therapeutic Issues for Patients in Psychotherapy

Health promotion and exercise is recognized as an important ingredient in health maintenance. Within the diagnostic category of obsessive-compulsive disorders has been the increased recognition by clinicians of a phenomena best described as exercise dependence. Reviewed herein is its definition, theoretical framework and a spectrum of factors often associated with exercise. Realizing that exercise dependence as a clinical entity is not yet recognized in either the International Classification of Disorders (ICD-9) or the Diagnostic and Statistical Manual (DSM-IV-R), proposed criteria for its inclusion are offered. Where a pattern of behavior shows the presence of symptoms consistent with exercise dependence, clinical diagnosis should be made to assure that appropriate treatment might be offered to manage the condition and continue to make exercise an important part of a healthy lifestyle. Diagnostic and therapeutic considerations are offered for the contemporary psychotherapist.     

A Modified ESID Approach to Studying Mental Illness and Homelessness

This paper describes 15 years of research on homelessness using a modified ESID approach. The article summarizes the results of several needs assessment studies; describes the development and evolution of alternative treatment models to assist homeless individuals with severe mental illness; summarizes results of three outcome evaluation studies; and discusses issues of treatment implementation, treatment diffusion, and dissemination.     

Improving day-treatment services for adults with severe disabilities: a norm-referenced application of outcome management

We evaluated an outcome management program for working with staff to improve the performance of adults with severe disabilities in a congregate day-treatment setting. Initially, observations were conducted of student task involvement and staff distribution of teaching interactions across students in four program sites. Using recent normative data to establish objective goals for student performance, management intervention was warranted in two of the sites. A six-step outcome management program was then implemented in the two sites. The program involved defining desired student and staff outcomes, systematic monitoring of the outcomes, staff training, and supportive and corrective feedback. The outcome management program was accompanied by increases in student on-task behavior and staff distribution of teaching interactions in both sites. The increases brought the levels of on-task behavior above the normative average; on-task behavior was maintained above the baseline average for over 1 year in both sites. These results are discussed in terms of the benefits of relying on normative data for objectively evaluating and improving service delivery systems. Discussion of future research needs focuses on applying the outcome management program to other settings and services for people with disabilities.     

Nine Months of Multicomponent Behavioral Treatment for ADHD and Effectiveness of MTA Fading Procedures

We examined 9-month data from the 14-month NIMH Multimodal Treatment Study of Children with ADHD (the MTA) as a further check on the relative effect of medication (MedMgt) and behavioral treatment (Beh) for attention-deficit/hyperactivity disorder (ADHD) while Beh was still being delivered at greater intensity than at 14-month endpoint, and conversely as a check on the efficacy of the MTA behavioral generalization/maintenance procedures. Intention-to-treat analysis at 9 months showed essentially the same results as at 14 months, after Beh had been completely faded; MedMgt and the combination (Comb) of medication and Beh were significantly superior to Beh and community care (CC) for ADHD and oppositional-defiant (ODD) symptoms, with mixed results for social skills and internalizing symptoms. All treatment-group differences examined as changes in slopes from 9 to 14 months were nonsignificant (we found general improvement for all groups). Slopes from baseline to 9 months correlated highly (r > .74, p < .0001) with slopes from baseline to 14 months for all groups. The time function from baseline to 14 months showed a significant linear, but not quadratic, trend for the main outcome measure (a composite of parent- and teacher-rated ADHD and ODD symptoms) for all groups. Findings suggest that in contrast to the hypothesized deterioration in the relative benefit of Beh between 9 and 14 months (after completion of fading), the MTA Beh generalization and maintenance procedures implemented through 9 months apparently yielded continuing improvement through 14 months, with preservation of the relative position of Beh compared to other treatment strategies.