Demographic, Clinical, and Functional Characteristics of Youth Enrolled in Six California Systems of Care

We describe the demographic, functional, and clinical status of children served across six California counties implementing a longstanding integrated system of care approach called the California System of Care Model. The children enrolled in the care systems are an ethnically diverse group of predominantly pre-adolescent and adolescent males. The level of functional impairment and degree of symptomatology is high. Seventy to 80% of the youth were in the clinical or borderline clinical ranges as measured by the Child Behavior Checklist. Scores on the Child and Adolescent Functional Assessment Scale, provided by the treating clinician, indicated that up to 94% of the youth were in the moderate to severe levels of impairment. Children and adolescents rated themselves on the Youth Self Report as having lower levels of impairment than did parents. Caregivers and youth ratings emphasized externalizing rather than internalizing problems. Clinician ratings as captured by the CAFAS and the clinical diagnoses, presented a mix between internalizing and externalizing diagnoses and functional impairment areas. The six counties are serving children who have levels of impairment, similar to, or higher than, youth enrolled in other systems of care nationwide.     

Relational Risk and Its Personal Correlates in Strategic Alliances

In this study we focus on the perception of one particular type of risk in the context of strategic alliances—relational risk. Perceived relational risk refers to the degree to which decision makers are concerned with the partner's opportunistic behavior in cooperative efforts. We develop a measure of relational risk in strategic alliances, and empirically examine some of its personal correlates. Based on a survey of senior executives of corporations and MBA students, we found partial support for the principal hypothesis that the perception of relational risk for prospective strategic alliances is related to an individual's age and trust in people.     

Narcissism and Grace: Inherent Incompatibility

Narcissistic conditions are highly prevalent in clinical treatment settings. However, most developmental theories include only maturational and interpersonal aspects of functioning without including spiritual and Christian-based factors. In working with narcissistic disorders, it is necessary for the patient to incorporate grace and forgiveness into their sense of self, through the transmuting internalization of vicarious introspection of the therapist. This paper asserts that grace is a necessary and vital prerequisite for developmental and spiritual growth. Specific examples are included to help therapists identify and work within the therapeutic transference to help the patient integrate grace into their identity.     

儿童欺负行为的类型及其相关因素

本研究采用Olweus欺负问卷中文修订版对我国6471名中小学生进行调查,探讨了中小学生欺负行为的类型特点及其相关因素,结果发现:(1)在小学和初中阶段,直接言语欺负的发生率最高,其次是直接身体欺负,间接欺负的发生率最低。(2)小学和初中男生受直接身体欺负的比例显著高于女生,直接言语欺负没有显著的性别差异。(3)小学阶段三类欺负行为的发生率存在显著的年级差异,三年级儿童受直接身体欺负的比例极显著地高于四、五年级,受直接言语欺负的比例总体上随儿童年级升高而上升,受间接欺负的比例在2-4年级之间相对稳定,5年级出现极显著的下降;在初中阶段三类欺负行为的发生率相对稳定。(4)欺负者大多与受欺负者同龄或年长于受欺负者,初中学生的欺负呈现出明显的“团体化”特点。     

浅谈分子生物学与临床医学研究的结合

随着分子生物学理论和技术从基础研究渗透到临床各个学科,对临床诊断和治疗水平的提高起到了积极的推动作用。但在实际工作中还存在着发展不平衡以及认识与理解上的误区。就分子生物学与临床医学研究的相结合的现状、存在问题及相应对策,以及今后我国临床医学分子生物学研究的发展前景进行了较广泛深入的讨论。     

ENLARGING THE INTERDISCIPLINARY CIRCLE: JOAN KOSS‐CHIOINO'S AND PHILIP HEFNER'S APPROACH TO SPIRITUAL TRANSFORMATION AND HEALING

In the current scientific age there exists in academia a certain reservation regarding, even a fear of contact with, controversial issues such as faith healing or shamanism or even spiritual transformation. Although classical medicine, neurobiology, and possibly even social circumstances and forces are recognized, researching the controversial issues evoked may be frowned upon and even be risky for one's academic career. Fortunately, Joan Koss‐Chioino, Philip Hefner, and their colleagues (anthropologists, artists, neuroscientists, physicians, psychologists, psychiatrists, sociologists, theologians, and others) have not shrunk from doing so. The result, reviewed here in some detail, goes beyond what is common knowledge and points the way to further beneficial insights via open‐minded interdisciplinary research.     

Cross-Cultural Generalizability of CBCL Syndromes Across Three Continents: From the USA and Holland to Australia

The study asked how well Achenbach's 8-factor cross-informant model for the Child Behavior Checklist (Achenbach, 1991a, 1991b, 1991c) fits clinic data in the USA, Holland, and Australia. DeGroot et al.'s Dutch 8-factor model (DeGroot, Koot, & Verhulst 1994) was also tested for its cross-cultural generalizability. Achenbach's matched clinical sample data (N = 2110) were analyzed and contrasted with the previously reported Dutch findings (N = 2335), as well as a new data set collected on clinic referred children and adolescents in Australia (N = 2237). Confirmatory factor analyses supported the Dutch as much as the American model in the USA, Holland, and Australia. Although about 90% of items showed convergent validity across models and countries, the attention and especially the social problems factor found least support. Most double loadings in the current models were not upheld. Instead, additional analyses discovered a number of unmodelled loadings including many cross-loadings. This led to the redefinition of the social problems factor as a mean aggression factor (with associated social problems) whereas the original aggression factor focuses on emotional acting out and the delinquent factor describes an evasive, covert type of antisocial behavior. Overall most support was obtained for the withdrawn, somatic, anxious/depressed, thought problems, and aggressive factors.     

Pediatric Health-Related Quality-of-Life Measurement Technology: Intersections between Science, Managed Care, and Clinical Care

The demand for health care outcomes assessment is increasing, driven by the proliferation of managed care as a form of health care financing. Providers, consumers, and payers can use health care outcomes to improve the efficiency and quality of care, spur performance improvement, and demonstrate accountability. This review introduces health outcomes and focuses on one particular outcome—pediatric health-related quality of life (HRQOL), exemplified by the PedsQL, a brief, practical, reliable, valid, and responsive measure of pediatric HRQOL. HRQOL measurement has the potential, in pediatric clinical practice, to improve assessment, clinical management, and treatment evaluation if practical, conceptual, and empirical challenges are addressed. These issues are discussed and directions for future research are described that would demonstrate the value of HRQOL measurement in pediatric clinical settings.     

Reflections of a reluctant clinical ethicist: Ethics consultation and the collapse of critical distance

The obvious appeal and growing momentum of clinical ethics in academic medical centers should not blind us to a potential danger: the collapse of critical distance. The very integration into the clinical milieu and the processes of clinical decision making, that clinical ethics claims as its greatest success, carries the seeds of a dilution of ethics' critical stance toward medicine and medical education. The purpose of this paper is to suggest how this might occur, and what potential contributions of ethics to medicine might be sacrificed as a result. Medical sociology will be used for comparison. Sociologists have found that they may function either as students and critics of established medical practices and educational philosophies, or as collaborative participants in them — but rarely both. It may be that professional ethics is most effective when it plays the role of stranger rather than insider, and is continually able to question the most basic assumptions and values of the enterprise with which it is associated. As with medical sociology, ethics and humanities must ask to what extent their desire for acceptance in the clinic requires their acceptance of the clinic: specifically, acceptance of basic assumptions about optimal ways of organizing medical education, socializing physicians-in-training, providing care, and even of defining medical ethics itself. The paper concludes by recommending that ethics reassert its strangeness in the medical milieu even as it assumes a more prominent role within the medical center.