Family homelessness, subsequent CWS involvement, and implications for targeting housing interventions to CWS-involved families

BACKGROUND

Homelessness is a risk factor for family involvement with child welfare services (CWS). Housing interventions are promising-but reasons for this are not well understood, and housing resources could be better targeted to families at risk of increased CWS involvement.

OBJECTIVE

We sought to better understand the relationship between homelessness and CWS involvement and examine whether homeless shelter data could combine with CWS data to enhance intervention targeting.

PARTICIPANTS AND SETTING

For 4 years, we followed 2063 families investigated by the San Francisco Human Services Agency in 2011.

METHODS

Matching CWS data to homeless shelter data, we fit Cox models to examine the relationship between shelter use and subsequent CWS outcomes and produced ROC curves to judge model accuracy with and without shelter information.

RESULTS

Absent CWS covariates (family demographics, CWS history, and family safety and risk), past shelter entry predicted repeat maltreatment referral (HR = 1.92, p < .001), in-home case opening (HR = 1.51, p < .05), and child removal (HR = 1.95, p < .01), but not child reunification. With CWS covariates, past shelter use no longer predicted case opening and child removal, but still predicted referral (HR = 1.58, p < .01). Shelter data did not contribute to models' predictive accuracy.

CONCLUSIONS

We find mixed evidence that shelter use independently leads to CWS involvement. Housing interventions might help by addressing present housing problems and family experiences correlated with past shelter use. However, we find no evidence that data matches with shelter systems could enhance targeting.

Predicting Violent Behavior: What Can Neuroscience Add?

The ability to accurately predict violence and other forms of serious antisocial behavior would provide important societal benefits, and there is substantial enthusiasm for the potential predictive accuracy of neuroimaging techniques. Here, we review the current status of violence prediction using actuarial and clinical methods, and assess the current state of neuroprediction. We then outline several questions that need to be addressed by future studies of neuroprediction if neuroimaging and other neuroscientific markers are to be successfully translated into public policy.

Diagnostic efficiency of the SDQ for parents to identify ADHD in the UK: a ROC analysis

Early, accurate identification of ADHD would improve outcomes while avoiding unnecessary medication exposure for non-ADHD youths, but is challenging, especially in primary care. The aim of this paper is to test the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative sample to develop scoring weights for clinical use. The British Child and Adolescent Mental Health Survey (N = 18,232 youths 5-15 years old) included semi-structured interview DSM-IV diagnoses and parent-rated SDQ scores. Areas under the curve for SDQ subscales were good (0.81) to excellent (0.96) across sex and age groups. Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 21.3×. For discriminating ADHD from other diagnoses, accuracy was fair (<0.70) to good (0.88); Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 4.47×. The SDQ is free, easy to score, and provides clinically meaningful changes in odds of ADHD that can guide clinical decision-making in an evidence-based medicine framework.

Analysing the Expert Judgment of a Rehabilitation Counsellor: A Case Study

This case study analysed the expert judgments of a rehabilitation counsellor. The counsellor was given 37 accident victims' self-ratings of health, energy, daily activities, self-esteem, personal relations, financial resources and living conditions. The accident victims also rated their own overall quality of life as poor or good. The expert was required to make judgments about whether the quality of life was poor or good in each case and matched the ratings of the accident victims in 64.8% of cases. The results suggest that under conditions of uncertainty and complexity an expert may be more accurate than chance but still fail to use the properties of information to their maximum advantage.

Clinical Decision-Making in Community Children's Mental Health: Using Innovative Methods to Compare Clinicians With and Without Training in Evidence-Based Treatment

BACKGROUND

Mental health professionals' decision-making practice is an area of increasing interest and importance, especially in the pediatric research and clinical communities.

OBJECTIVE

The present study explored the role of prior training in evidence-based treatments on clinicians' assessment and treatment formulations using case vignettes. Specifically, study aims included using the Naturalistic Decision Making (NDM) cognitive theory to 1) examine potential associations between EBT training and decision-making processes (novice versus expert type), and 2) explore how client and family contextual information affects clinical decision-making.

METHODS

Forty-eight clinicians across two groups (EBT trained=14, Not EBT trained=34) participated. Clinicians were comparable on professional experience, demographics, and discipline. The quasi-experimental design used an analog "think aloud" method where clinicians read case vignettes about a child with disruptive behavior problems and verbalized case conceptualization and treatment planning out-loud. Responses were coded according to NDM theory.

RESULTS

MANOVA results were significant for EBT training status such that EBT trained clinicians' displayed cognitive processes more closely aligned with "expert" decision-makers and non-EBT trained clinicians' decision processes were more similar to "novice" decision-makers, following NDM theory. Non-EBT trained clinicians assigned significantly more diagnoses, provided less detailed treatment plans and discussed fewer EBTs. Parent/family contextual information also appeared to influence decision-making.

CONCLUSION

This study offers a preliminary investigation of the possible broader impacts of EBT training and potential associations with development of expert decision-making skills. Targeting clinicians' decision-making may be an important avenue to pursue within dissemination-implementation efforts in mental health practice.

Distinctive emotional responses of clinicians to suicide-attempting patients--a comparative study

BACKGROUND

Clinician responses to patients have been recognized as an important factor in treatment outcome. Clinician responses to suicidal patients have received little attention in the literature however, and no quantitative studies have been published. Further, although patients with high versus low lethality suicidal behaviors have been speculated to represent two distinct populations, clinicians' emotional responses to them have not been examined.

METHODS

Clinicians' responses to their patients when last seeing them prior to patients' suicide attempt or death were assessed retrospectively with the Therapist Response/Countertransference Questionnaire, administered anonymously via an Internet survey service. Scores on individual items and subscale scores were compared between groups, and linear discriminant analysis was applied to determine the combination of items that best discriminated between groups.

RESULTS

Clinicians reported on patients who completed suicide, made high-lethality attempts, low-lethality attempts, or died unexpected non-suicidal deaths in a total of 82 cases. We found that clinicians treating imminently suicidal patients had less positive feelings towards these patients than for non-suicidal patients, but had higher hopes for their treatment, while finding themselves notably more overwhelmed, distressed by, and to some degree avoidant of them. Further, we found that the specific paradoxical combination of hopefulness and distress/avoidance was a significant discriminator between suicidal patients and those who died unexpected non-suicidal deaths with 90% sensitivity and 56% specificity. In addition, we identified one questionnaire item that discriminated significantly between high- and low-lethality suicide patients.

CONCLUSIONS

Clinicians' emotional responses to patients at risk versus not at risk for imminent suicide attempt may be distinct in ways consistent with responses theorized by Maltsberger and Buie in 1974. Prospective replication is needed to confirm these results, however. Our findings demonstrate the feasibility of using quantitative self-report methodologies for investigation of the relationship between clinicians' emotional responses to suicidal patients and suicide risk.

In search of patient characteristics that may guide empirically based treatment selection for personality disorder patients-a concept map approach

Using the concept map method, this study aimed to summarize and describe patient characteristics pertinent to treatment selection for patients with personality disorders (PDs). Initial patient characteristics were derived from the research literature and a survey among Dutch expert clinicians. Concept mapping is a formalized conceptualization procedure that describes the underlying cognitive structures people use in complex tasks, such as treatment allocation. Based on expert opinions of 29 Dutch clinicians, a concept map was generated that yielded eight domains of patient characteristics, i.e., Severity of symptoms, Severity of personality pathology, Ego-adaptive capacities, Motivation and working alliance, Social context, Social demographic characteristics, Trauma, and Treatment history and medical condition. These domains can be ordered along two bipolar axes, running from internal to external concepts and from vulnerability to strength concepts, respectively. Our findings may serve as input for the delineation of algorithms for patient-treatment matching research in PD.

The Canadian Problem Gambling Index: an evaluation of the scale and its accompanying profiler software in a clinical setting

Across two studies we assessed the clinical utility of the Canadian Problem Gambling Index (CPGI). In Study 1, the scored items on the CPGI significantly correlated with those of the South Oaks Gambling Screen (SOGS), yet their shared variance was low. Importantly, clinician evaluation of the client's level of pathology was more strongly associated with that revealed by the CPGI than the SOGS. In terms of utility, clinicians found the non-scored items on the CPGI more useful in treatment than those included with the SOGS. In Study 2, the effectiveness of the CPGI profiler (CPGI-P) software, which graphically depicts problematic gambling-relevant attitudes and behaviours, was assessed. Although clients had difficulties using the CPGI-P interface, they overwhelmingly indicated that the output prompted action to address their gambling. The clinicians were less enthusiastic as they felt the output did not help clients truly understand their gambling problems. Such sentiments were reiterated by the clinicians at a 6 months follow-up. The use of the SOGS and possible adoption of the CPGI (as well as the CPGI-P) in a clinical setting are discussed.