Client predictors of short-term psychotherapy outcomes among Asian and white American outpatients

PURPOSE

To examine predictors of psychotherapy outcomes, focusing on client characteristics that are especially salient for culturally diverse clients.

METHOD

Sixty clients (31 women; 27 White Americans, 33 Asian Americans) participated in this treatment study. Client characteristics were measured at pretreatment, and outcomes were measured postfourth session via therapist ratings of functioning and symptomatology. Regression analyses were utilized to test for predictors of outcomes, and bootstrap analyses were utilized to test for mediators.

RESULTS

Higher levels of somatic symptoms predicted lower psychosocial functioning at posttreatment. Avoidant coping style predicted more negative symptoms and more psychological discomfort. Non-English language preference predicted worse outcomes; this effect was mediated by an avoidant coping style.

CONCLUSIONS

Language preference, avoidant coping style, and somatic symptoms predicted treatment outcome in a culturally diverse sample. Findings suggest that race/ethnicity-related variables may function through mediating proximal variables to affect outcomes.

Integrating Risk Context Into Risk Assessments

The context in which offenders are released is an important component of conducting risk assessments. A sample of 257 supervised male parolees were followed in the community ( M = 870 days) after an initial risk assessment. Drawing on community-based information, the purpose of this study was to evaluate the recently developed Risk Context Scale. Four domains from the Risk Context Scale include Resource Engagement, Social Network Presence, Integration of Care, and Social Stability. Using mediation analysis, an initial static risk probability was altered up to 26% by accounting for risk context. Implications of the present results include a broader explanation of recidivism, offering intervention strategies, and further individualizing risk assessments.

The Nursing Observed Illness Intensity Scale (NOIIS)

Inpatient progress is monitored mostly via the observation conducted by nursing staff. These tend to be unstructured, vary in reliability between different staff members, and be dependent on what has been written in nursing notes. The Nursing Observed Illness Intensity Scale (NOIIS) was devised to provide a more objective measure of behavioural improvement and symptom reduction. The scale is completed by qualified nurses at the end of every shift, based on everyday nursing observation and interaction with patients, and scores are entered on a NOIIS 'temperature' chart. In this study, more than 6000 ratings were captured on 106 admissions to a psychiatric intensive care unit. Inter-rater reliability of the scale was found to be satisfactory, and validity against the Brief Psychiatric Rating Scale good. Scores were shown to relate to the social organization and treatment methods of the unit. Recovery curves differed significantly by diagnosis, with patients having schizophrenia showing the slowest improvement. From a clinical point of view, the NOIIS can be used to track progress, response to changes in treatment and readiness of the patient for discharge; aids staff deployment; and can be used for clinical audit. For research, the scale can be used in clinical trials of treatment outcomes.

Integrative multidisciplinary treatment in the public sector: a pilot study

Integrative Multidisciplinary Treatment (IMT) emphasizes factors common to evidence-based treatments for borderline personality disorder (BPD) and is suitable for implementation in a public sector setting staffed by clinicians with diverse theoretical backgrounds. Preliminary results suggested decreases in psychiatric disturbance, depression, suicidality, hospitalizations, and emergency room visits, and increases in quality of relationships and quality of life. Results generalized across patients with and without BPD, with two exceptions: hospitalizations and suicidality.

The measurement of psychotic acuity by nursing staff

Accurate evaluation of patients' psychotic state is essential to decrease psychotic symptoms and protect the patient and others. The aim of this paper is to conduct a literature review in order to access the utility, reliability and validity of current rating scales that are purported to measure psychotic acuity of inpatient population. A search of a number of electronic databases was undertaken to retrieve potential articles that focus on the measurement of acute psychosis. We identified some conceptual and theoretical problems when using a scale that is monitoring the progress of discharge and assesses the outcome of treatments. The findings revealed a difficulty in finding a commonly agreed definition of acute psychosis and a problem of obtaining frequent measures, and the frequency of measurement and fluctuation in psychosis. The most dominant scales in assessing psychosis were reviewed: the Global Assessment of Functioning Scale, the Brief Psychiatric Rating Scale and the Positive and Negative Symptom Scale. Several issues related to the scales' inter-rater reliability and construct validity remain unexplored. None of these scales addressed the conceptual and theoretical problems that we identified. A new scale that will measure acuity of symptoms in inpatient settings needs to be created.