Use of medical and behavioral health services by adolescents with bipolar disorder

OBJECTIVE

This study compared use of medical and behavioral health care by adolescents with bipolar disorder and other adolescents and identified areas in need of more clinical attention.

METHODS

Medical and behavioral health insurance claims from 1996 for 100,880 adolescents were examined and categorized. Differences between and among various categories of disease were explored by using multivariate analyses.

RESULTS

Among the 10,970 adolescents who used at least one behavioral health service, adolescents with bipolar disorder (N=326) had significantly higher behavioral health costs than those with mood or non-mood disorders, a result driven by these adolescents' significantly higher hospital admission rates for behavioral health care. Adolescents with bipolar disorder also had significantly higher medical admission rates compared with adolescents who had other behavioral health diagnoses. More than half of the 14 medical admissions for adolescents with bipolar disorder were due to drug overdose.

CONCLUSIONS

Reallocation of medical and behavioral health resources to improve ambulatory treatment of bipolar disorder among adolescents has the potential to decrease the use and costs of health care while improving the welfare of these adolescents and their families.

Reliability of the services for children and adolescents-parent interview

OBJECTIVE

To describe the psychometric properties and test the reliability of a new instrument designed to measure mental health services use within pediatric clinical samples, the Services for Children and Adolescents-Parent Interview (SCAPI), which was developed by the National Institute of Mental Health Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder (MTA).

METHOD

Similarities and differences with other measures of services use are described. Ten types of services are measured by the SCAPI. Formal test-retest reliability testing was carried out in 104 subjects with a mean time between tests of 18 days.

RESULTS

Test-retest kappa values ranged from 0.49 to 1.00, with an overall kappa value for all services of 0.97. Seven of the 10 service types had kappa values of 0.75 or higher, indicating excellent reliability. In addition, matched responses on specific questions about reasons for seeking services, starting and ending dates, number and length of visits, and type of provider seen were more than 75% for most service categories, consistently so for reporting of medications and school services.

CONCLUSIONS

The SCAPI is a reliable instrument for assessing mental health and related services use and may be an especially valuable adjunct in studies involving clinical samples, especially clinical trials.

Predictors for emotionally distressed adolescents to receive mental health care

PURPOSE

To determine predictors for emotionally distressed adolescents from different racial/ethnic groups to receive psychological counseling.

METHODS

This study used secondary database analysis of the restricted-use National Longitudinal Study of Adolescent Health, using predictor variables from Wave 1 and the outcome variable from Wave 2. Adolescents scoring in the top third of an emotional distress scale (n = 3963) were analyzed by race/ethnicity. Multivariate analyses were based on the access-to-care model.

RESULTS

Emotionally distressed Blacks reported receiving psychological counseling significantly less than Whites and Hispanics (8% vs. 19% and 16%, respectively). The most important factors associated with receiving counseling for each racial/ethnic group were: Whites (n = 1681): suicidality and urban area, [Adjusted odds ratio (AOR) 1.9, 95th confidence interval (CI) (1.4, 2.6)] and [AOR 1.4, 95th CI, 95th CI (1.0, 1.8)], respectively; Blacks (n = 677): urban area [AOR 2.9, 95th CI (1.4, 6.0)]; Hispanics (n = 5326): suicidality and barriers to care, [AOR 2.2, 95th CI (1.0, 4.7)] and [AOR 0.4, 95th CI (0.2, 0.7)], respectively.

CONCLUSIONS

Predictors for receiving counseling varied for different racial and ethnic groups of adolescents. Even after adjusting for family income and parent education, distressed black adolescents were less likely to receive counseling. The findings specific to distressed black adolescents indicate that other factors may underlie differences in utilization of mental health services.

[Scholar absenteeism and use of health services in children and adolescents with wheezing]

INTRODUCTION

Asthma is an important problem at the primary care level where almost 97% of the cases are managed. Brazil shows high rates of the disease nevertheless few is known about the characteristics related to school absenteeism and the health care usage among urban pediatric population of Duque de Caxias County, Rio de Janeiro.

OBJECTIVES

To obtain an estimate of the prevalence of school absenteeism and to evaluate the use of health care related to wheezing in asthmatic and non asthmatic children and adolescents.

MATERIAL AND METHODS

An observational cross-sectional study was carried out using a questionnaire for a prospective data collection. The gold standard for asthma was a minimal increment of 12% in the forced expiratory volume of the first second (FEV1), after a bronchodilatation test.

RESULTS

211 patients seeking emergency care for a number of conditions with ages between 5 and 15 years were evaluated. Sample asthma prevalence and reported wheezing rates were: 22% (47/211) and 47% (98/211). About 67% (141/211) of the families had an annual income lesser than US dollar 3600. Asthmatic and non-asthmatic patients showed, respectively, the following averages and rates: 1) emergency department visits: 40.4% (19/47) and 29.3% (48/164), 2) ambulatory visits: 34% (16/47) and 14.6% (24/164) (p = 0.003), 3) hospitalizations: 6.4% (3/47) and 4.9% (8/164), 4) number of consultations in ambulatory: 1.74 (SD = 2.71) and 0.47 (SD = 1.44) (p = 0.00003), 5) number of visits in emergency department: 1.47 (SD = 2.36) and 0.95 (SD = 2.15).

CONCLUSION

The results are relevant as they describe asthma morbidity, showing that wheezing is a heavy burden to the population of Duque de Caxias. Further studies are needed to better evaluate the group of children and adolescents that although being classified as non-asthmatic presented some characteristics that were to the asthmatic patients.

Illness experiences of homeless youth

The purpose of this study was to document the illness experiences of homeless youth. The research was a focused ethnography with 45 clinic- and street-based homeless youth aged 15 to 23 years. The authors noted gender differences for health-seeking behaviors, with most male youth reporting embarrassment about needing to seek care, and female youth reporting fears over safety issues while ill and homeless. Most youth under age 18 stated that they were often denied health care at hospitals because of their underage status, and youth over age 18 stated that health care bills contributed to their inability to obtain stable housing. Street-based youth reported more illnesses related to substance use and greater reliance on emergency departments for health care than clinic-based youth did. Policies and programs focused on improving the health of homeless youth need to address the differences in illness experiences by age, gender, and sampling site.

Use of health and school-based services in Australia by young people with attention-deficit/hyperactivity disorder

OBJECTIVE

To examine use of health (including psychiatric) and school-based services by children and adolescents who met symptom criteria for attention-deficit/hyperactivity disorder (ADHD), the factors associated with service use, and barriers to service access.

METHOD

The relationship between parents' perceptions of children's need for professional help, the impact of children's problems on children and parents, and services used during the previous 6 months were examined in a national sample of 398 children and adolescents with ADHD symptoms aged 6 to 17 years (70% response rate). Information was obtained from parents who completed the Diagnostic Interview Schedule for Children Version IV and standard questionnaires. Data collection took place between February and May 1998.

RESULTS

Only 28% of those with ADHD symptomatology had attended health or school-based services. Among these, 41% had attended both health and school-based services, 39% had attended only health services, and 20% had attended only school-based services. Sixty-nine percent of parents attending health services wanted additional help. Parental perceptions that children needed professional help, children's functional impairment, the impact of problems on parents, and comorbid depressive or conduct disorders had a significant and independent relationship with service use.

CONCLUSIONS

A minority of children and adolescents with ADHD symptomatology receives professional help for their problems in Australia. Counseling is the most frequent help provided, with many parents wanting additional help beyond that already provided. Factors other than children's ADHD symptomatology have a significant relationship with service attendance. Practical issues, including the cost of services and waiting lists are the most common barriers cited by parents as hindering access to services.

Infrequency of sexually transmitted disease screening among sexually experienced U.S. female adolescents

CONTEXT

Since 1993, the Centers for Disease Control and Prevention and professional medical organizations have recommended that all sexually experienced female adolescents receive annual screening for Chlamydia trachomatis. Whether adolescents receive this care is largely unknown.

METHODS

Reports of receipt of testing or treatment for a sexually transmitted disease (STD) in the past year, as well as sites of care, were obtained from 3,987 sexually experienced females in grades 7-12 who participated in Wave 1 of the National Longitudinal Study of Adolescent Health, conducted in 1995. Logistic regression was used to determine predictors of reporting care.

RESULTS

Eighteen percent of all participants reported having received STD services in the past year. Of those who reported having had a routine physical examination in the past year, 22% reported receipt of STD services. The proportion reporting STD care increased linearly with age from 9% of 12-13-year-olds to 25% of those 19 or older. In adjusted analyses, the odds of reporting testing or treatment were elevated among participants who had had a physical examination in the past year (odds ratio, 2.1), those with Medicaid or Medicare insurance (1.9), black women (1.5) and older adolescents (1.2). Adolescents most often reported having received STD care at a community health center (44%) or a private physician's office (31%).

CONCLUSIONS

Continued inadequate screening may contribute to persisting high prevalence of chlamydia infection among adolescents. Future research is needed to determine whether the proportions of adolescents receiving recommended STD screening have increased over time.

The services for children and adolescents-parent interview: development and performance characteristics

OBJECTIVE

To date, no instrument has been developed that captures children's services use across primary care, specialty mental health, and other settings, including setting, treatment type, provider discipline, and length and intensity of specific interventions over varying follow-up periods. The authors developed a highly structured services assessment measure [Services for Children and Adolescents-Parent Interview (SCAPI)] for use in the National Institute of Mental Health Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder (MTA).

METHOD

After successfully piloting and refining the SCAPI during initial phases of the MTA, the authors used this measure at 24 months post-randomization to ascertain the previous 6 months of services use for all participating (516 of 579) MTA children and families and 285 age- and gender-matched classroom control children.

RESULTS

Findings revealed meaningful, face-valid differences between MTA and control children in levels and types of services used during the previous 6-month period. Services use data reported by parents was substantially in accord with data independently gathered by the research data center. Site variations were found in the level and use of several specific services, such as individual child psychotherapy (sites ranged from 0% to 6.8% among classroom controls compared with 9.7% to 46.1% among MTA participants) and special education services (0% to 14.6% among classroom controls, 27.5% to 34.8% among MTA participants), consistent with differences reported in other studies.

CONCLUSIONS

These data support the descriptive validity of SCAPI-ascertained services use data and indicate that the SCAPI can provide investigators and policymakers a valid means of assessing services type, intensity, onset and offset, provider type, and content.

Disparities in routine physical examinations among in-school adolescents of differing Latino origins

PURPOSE

To estimate the prevalence of routine physical examination among in-school adolescents of differing national Latino origins and to assess associations with gender, age, immigrant generational status, language spoken at home, parental education, poverty level, family structure, and insurance status.

METHODS

Cross-sectional analysis of Wave I of the National Longitudinal Study of Adolescent Health conducted during 1995. Our sample was limited to adolescents in grades 7 through 12 of Mexican (n = 1657), Cuban (n = 490), Puerto Rican (n = 555), and Central/South American or Dominican (C/S American or DR) (n = 427) origins. We used multivariate logistic regression for survey data to conduct the data analyses.

RESULTS

Mexican-origin adolescents were less likely to report a routine physical examination in the previous year, compared with other Latino populations [prevalence (95% confidence interval)]: Mexicans, 47.7 % (42.0% -53.6%], Cubans 67.6% (57.4%-76.4%), Puerto Ricans 65.2% (58.4%-71.4%), and C/S American or DR (57.0% [47.3-66.2]). Among Mexican-origin adolescents, having a college-educated parent or insurance was associated with receiving care (adjusted prevalence odds ratio [95% confidence interval]), 2.12 (1.37-3.30) and 1.80 (1.31-2.47), respectively. For Cuban-origin adolescents, first-generation immigrants were less likely to receive care (0.31 [0.14-0.70]), and those living in a single-parent home were more likely to receive care (2.83 [1.52-5.25]). Having a routine physical examination among adolescents of C/S American or DR origins was associated with incomes above the poverty level (2.29 [1.10-4.77] and insurance (2.33 [1.10-4.91]).

CONCLUSIONS

Reflecting the heterogeneity of Latino adolescents, the prevalence of routine physical examination and factors associated with it varied by national origin subgroup. These differences should be considered when developing strategies to better address the health needs of Latino youth.

Socio-demographic and clinical characteristics of Jamaican adolescents with HIV/AIDS

BACKGROUND

Clinical symptomatology and socio-demographic factors have not been characterized in Jamaican adolescents with HIV/AIDS.

METHODS

We studied these factors in 25 HIV-positive Jamaican adolescents, 10-19 years of age, who were seen at the Centre for HIV/AIDS Research, Education, and Services (CHARES) between the years 1996 and 2002. Data were collected between June 2003 and August 2003 from CHARES social work files and The University Hospital of the West Indies (UHWI) medical records. Microsoft Excel was used to compile descriptive statistics for the data.

RESULTS

The mean age of HIV diagnosis was 15.6 (+/-3.09) years, and the mean age of enrollment at CHARES was 16.3 (+/- 2.9) years. Consensual sexual intercourse was the most prominent mode of transmission (56%), followed by vertical transmission (16%), unknown (16%), forced sexual intercourse (8%), and blood transfusion (4%). The predominant clinical presentations among these adolescent patients were generalized dermatitis (77.2%) and lymphadenopathy (50%). Of the patients for whom clinical status could be determined, 70% were "Severely Symptomatic ". Of these patients only 14% were recommended for antiretroviral treatment.

CONCLUSIONS

These findings reinforce the need to globally incorporate the goal of the 2002 Joint United Nations Programme on HIV/AIDS (UNAIDS) "to provide reproductive health services, including low-cost or free condoms, voluntary counselling and testing, diagnosis and treatment of sexually transmitted diseases and infections for adolescents in order to effectively prevent HIV infection " (1).

Study of young people attending an adolescent friendly centre

Adolescents are the individuals between the ages of 10 and 19 years and the youth are those between the ages of 15 to 24 years. World Health Organisation has therefore defined young people as individuals between the age group of 10 to 24 years. In our country Adolescents comprise more than one fifth (22%) of the total population. Therefore Family Health Division, Ministry of Health, established an adolescent friendly centre at Bir Hospital on 5th January 2002. This paper has tried to study and analyse the young population attending this centre at a fixed period of time. This study was carried out to a. Find out the total number of adolescents. b. Estimate their male: female ratio. c. Find out their ethnicity, address, marital status, education, and occupation d. Learn what Health and Development problems these young people have. This is a cross sectional study done at Bir Hospital adolescent friendly centre for a period of one year. All young people (adolescents and youths) coming to this centre within the specified period are included in this study. OPD register was used to collect the data, which was obtained and analysed manually. Total of 956 young people were provided healthcare and counselling services from this centre. Out of them, only 9.21 % were males. 887 (92.78%) of this population are adolescents, 69 (7.22%) are from 19 to 24 years age group and 880 (92.05%) of them are youth. Majority (28.56%) were Brahmins. 313 (32.74%) of these people were from outside the valley. 9 (10.23%) out of 88 boys and 384 (79.34%) out of 484 girls were married. 1.14% of boys and 14.63% of girls were illiterate. 4.55% of boys and 14.17% of girls had not completed the studies of standard five. 17.05% of boys and 47% of girls had not completed their school. 81.82% of boys and 38.36% of girls had joined the college. It also showed that 521 (54.50%) of these young people are students but 35.94% of girls are housewives. 278 (32.03%) girls presented with menstrual problems and 22.12% (192) came with pregnancy related problems and 15.27 % of these young people presented with the symptoms of various infections Twenty six (3%) girls came with features of anaemia and 22 (2.53%) girls had dropped in for family planning services. 20 (2.09%) of these young people had some psychological problem (mainly anxiety) and 9.62% of them had various types of skin problems. Adolescent friendly centre can play a vital role to support and help a good number of adolescents of the society. Key words: Adolescents, youths, and young people.

Adolescents in mid-sized and rural communities: foregone care, perceived barriers, and risk factors

PURPOSE

To investigate the perceived health care needs, foregone care, barriers to care, and associated risk factors in a non-urban population of adolescents.

METHODS

Tenth-grade students attending school and 15-17-year-old youth not attending school in a Midwestern county were surveyed or interviewed. Eighty-six percent provided usable data (n = 1948, 134 of whom were not in school). Nine focus groups (71 participants; 28 were not in school) were conducted in follow-up. Quantitative analysis included descriptive statistics, factor analysis, and logistic regression. Qualitative analysis of taped focus groups identified themes and interpreted findings.

RESULTS

Although 91% had seen a physician in the past 2 years, 44% reported foregoing needed care in the last year. Barriers for specific health needs were: cost of care and lack of insurance coverage for injuries and illnesses; lack of knowledge, distrust, and stigma for depression; embarrassment and transportation for birth control and sexually transmitted infections (STIs); and not knowing where or how to access care for drug and alcohol use. Youth most likely to have foregone care included those involved with dangerous activities under peer pressure (1.8, CI: 1.44-2.13), sexual intercourse (1.4, CI: 1.25-1.67), marijuana use (1.4, CI: 1.17-1.67), anticipating parenthood before age 20 years (1.2, CI: 1.04-1.33), male gender (2.5, CI: 1.89-2.86) and perceiving good health (1.7, CI: 1.45-1.85).

CONCLUSIONS

Nearly half of this non-urban population (both in and out of school) reported foregoing needed care in the last year. The barriers to care include lack of information, lack of access, poor insurance coverage, parenting issues, and concern about confidentiality.

Confidential reproductive health services for minors: the potential impact of mandated parental involvement for contraception

CONTEXT

Recent legislative efforts to implement mandated parental involvement for minor adolescents seeking family planning services threaten the rights of adolescents younger than 18 to access reproductive health care.

METHODS

State and federal laws and policies pertaining to minor adolescents' rights to access services for contraception and sexually transmitted diseases are reviewed, and research examining issues of parental involvement among adolescents using clinic-based reproductive health services is synthesized.

RESULTS

Attempts to mandate parental involvement for reproductive health care often focus on contraceptive services and are typically linked to federal or state funding. Studies of teenagers using clinic-based family planning services suggest that slightly more than one-half would obtain contraceptives at family planning clinics even if parental notification were required. Mandated parental involvement for contraception would discourage few teenagers from having sex, but would likely result in more teenagers' using the least effective methods, such as withdrawal, or no method at all. Family planning clinics encourage teenagers to voluntarily talk to their parents, but relatively little information is available about the extent to which activities to promote parent-child communication have been adopted.

CONCLUSIONS

Mandated parental involvement for teenagers seeking contraceptive care would likely contribute to increases in rates of teenage pregnancy. Research that will help clinics implement and improve efforts to encourage voluntary parental involvement is urgently needed.

Describing community needs: examples from the Circles of Care initiative

The assessment of community needs was one of the key foundations of the Circles of Care planning effort. Grantees identified a range of needs at the child, adolescent, family, programmatic, and community levels. This information, along with an emphasis on the importance of each community's history and culture, served as an important guide for each program as they developed their model systems of care.

Randomized trial of brief office-based interventions to reduce adolescent alcohol use

OBJECTIVE

To determine whether office-based interventions change adolescents' alcohol beliefs and alcohol use.

DESIGN

Randomized, controlled trial.

SETTING

Five managed care group practices in Washington, DC.

PARTICIPANTS

Consecutive 12- to 17-year-olds (N = 409) seeing primary care providers (N = 26) for general check-ups. Most of the adolescents (79%) were African American, 44% were male, and 16% currently drank.

INTERVENTIONS

Usual care (Group I), adolescent priming with alcohol self-assessment just prior to check-up (Group II), adolescent priming and provider prompting with adolescent self-assessment and brochure (Group III).

MAIN OUTCOME MEASURES

Adolescent alcohol beliefs at exit interview and self-reported behaviors at 6- and 12-month follow-up.

RESULTS

At exit interview, Groups II and III reported that less alcohol was needed for impaired thinking and a greater intent to drink alcohol in the next 3 months than Group I. At 6 months, Group III reported more resistance to peer pressure to drink, and Groups II and III reported more bingeing than Group I. At 1-year follow-up, controlling for baseline levels, Groups II (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.44-6.24) and III (OR, 2.86; CI, 1.13-7.26) reported more bingeing in the last 3 months than Group I. Group II reported more drinking in the last 30 days (OR, 2.31; CI, 1.31-4.07) and in the last 3 months (OR, 1.76; CI, 1.12-2.77) than Group I.

CONCLUSION

Brief office-based interventions were ineffective in reducing adolescent alcohol use but may increase adolescent reporting of alcohol use.

Understanding frequent emergency room use by Medicaid-insured children with asthma: a combined quantitative and qualitative study

BACKGROUND

Medicaid-insured asthmatic children frequently use emergency rooms (ERs). The reasons are unclear and have predominantly been studied in inner-city populations.

METHODS

We used billing data and focus groups to clarify reasons for frequent ER use by Medicaid-insured children with asthma living in rural areas and 23 towns in Kansas.

RESULTS

High ER utilization was concentrated in a small percentage of provider practices and children with asthma. Parents expressed strong preference for primary care treatment, and identified real or perceived difficulties in using primary care as the principal reasons for ER use. Difficulties included trouble contacting primary care physicians or obtaining urgent appointments, limited continuity of care, practice systems poorly adapted to patient needs, a perception that physicians preferred patients to use emergency services, and difficulties in obtaining medications. Parents were not aware of preventive measures or case management but reported high interest in these. Parents did not recall provider discussion of asthma risk factors/preventive strategies during primary care visits, although all children with high ER utilization had multiple risk factors, including exposure to high levels of household smoking.

CONCLUSIONS

Reducing ER utilization by Medicaid-insured asthmatic children depends on overcoming barriers to effective treatment in primary care and in greater attention to preventive services.

Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits

PURPOSE

To examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits.

METHODS

A total of 313 primarily African-American youth aged 11-21 years from 16 community-based organizations in suburban Maryland and in New York City completed questionnaires focusing on sexually transmitted diseases (STD) and health care. The analysis examined the relationship of sexual activity, attitudes, and presence of the parent at the health care visit with discussion of three sexual health topics and testing for STD at the most recent health care visit. Data were analyzed using Chi-square tests and logistic regression.

RESULTS

Overall, 74% of respondents reported that they had talked about at least one sexual health topic at their last health care visit but only 32% had discussed all three topics of sexual behavior, birth control, and STD. Females were more likely than males to discuss birth control although there were no gender differences in the overall likelihood of talking about a sexual health topic. Few adolescents initiated discussion of sexual issues. Positive attitudes toward discussing sexual issues with a provider and absence of a parent at the visit were independently associated with higher odds of discussing at least one sexuality topic and STD testing.

CONCLUSIONS

Although relatively large numbers of adolescents in the sample received sexual health assessments, the proportion was below recommended guidelines. The opportunity to speak privately with a clinician and having positive attitudes about discussing sex with a doctor appear to be important influences on the receipt of sexual health assessments. Improving the quality of adolescent preventive care will require creating a health care environment that facilitates discussion of sexual health issues.

Recommending STI Vaccination to Parents of Adolescents: The Attitudes of Nurse Practitioners

BACKGROUND

Future successful sexually transmitted infection (STI) vaccine programs will depend on health professionals' readiness to vaccinate adolescents.

GOAL

The goal was to examine nurse practitioners' willingness to recommend STI vaccines to parents of adolescent patients.

STUDY DESIGN

Participants rated 13 hypothetical vaccine scenarios, each of which was defined along 4 dimensions: infection; patient age, patient gender, and American Academy of Pediatrics (AAP) endorsement. Conjoint analysis was used to determine the relative contribution of each dimension to the ratings.

RESULTS

Generally, participants were amenable to recommending STI vaccines. Conjoint analysis indicated that AAP recommendation, infection, and patient age most strongly influenced ratings. There was particular interest in an HIV vaccine, but there was reluctance to vaccinate younger adolescents or to vaccinate without AAP endorsement.

CONCLUSIONS

Nurse practitioners are willing to recommend STI vaccines to parents of adolescents. Professional organization endorsement plays an important role in this decision. Younger-aged adolescents were not viewed as candidates for these vaccines.

[Modern approaches to child and adolescent health assessment at population level]

Despite the notion that the future of our society depends on children; their health is neither a key target in national health programmes, nor a key priority for research. Further improvement in child and adolescent health in Poland depends partly on appropriate data and on indicators applicable for planning, monitoring and evaluating purposes. Mortality statistics do not provide adequate description of the burden of disease in this age group and new indicators are required due to on increase in chronic diseases, and mental health problems. The aim of the paper is to discuss the concept of child and adolescent health and to stress the need of reliable data, correctly collected, analysed and interpreted. The paper compares the biomedical and biopsychosocial paradigms concerning children's health and well-being. Main determinants of health as alternative outcome measures, commonly used in health promotion, are also discussed. CHILD (The Child Health Indicators of Life and Development) project indicators are presented and their availability in Poland is described. A short international comparison based on five indicators related to health and health determinants, showed that Poland, a relatively low-income country in EU, is affected by health problems typical for Central and Eastern Europe (physical, such as relatively high mortality, poor oral health, and psychological, such as lower life satisfaction). However, new problems typical for more developed West European countries are expected to increase (like asthma and eating disorders). On the other hand, by comparison to other countries more children in Poland live in full families with supportive parents. In conclusion, there is a great progress in measuring children's health all over the world, although most of the new approaches have not been yet implemented in Poland. There is a special need to develop and implement multidimensional measures with well-established validity and reliability, such as quality of life scales and health profiles.

A review of clinical characteristics and residential treatments for adolescent delinquents with mental health disorders: a promising residential program

As treatment systems throughout the country have deinstitutionalized, under-use of community-based residential treatment systems has escalated. Reliance on juvenile justice systems for the care of the mentally ill adolescent has increased. There is considerable overlap between the mentally ill adolescent population within the community-based mental health systems and the offender population within the juvenile justice systems. With the inconsistent epidemiological prevalence and longitudinal treatment data, mental health treatment providers have also begun addressing this problem. This is currently being done by designing and implementing community-based residential mental health programs for delinquent adolescents of the juvenile justice system as well as nondelinquent adolescents within the mental health treatment systems. Providers have relied on both systems' literature in establishing theoretical treatment programs. The authors review critical treatment components currently used by both the treatment and juvenile justice systems. A promising integrative program is described.

The effects and treatment of community violence in children and adolescents: what should be done?

The amount of community violence that children and adolescents are exposed to is unsettling. Intensifying the issue, the amount of community violence that is wit-nessed or experienced directly by children and adolescents is increasing with time. It has been documented that children and adolescents who are exposed to community violence display a wide array of psychological symptoms, ranging from depression and anxiety to antisocial and suicidal behaviors. Many variables have been studied in an attempt to determine correlates, moderators, and mediators of exposure to community violence. Furthermore, many intervention strategies have been developed from the discovery of relationships among these variables. Despite these efforts, many children continue to suffer from the negative effects of exposure to community violence. The purpose of this article is to encourage mental health professionals to mobilize their efforts to help children, adolescents, and their families cope with the effects of community violence.