The Association of Quality of Life with Psychosocial Factors in Adolescents with Tourette Syndrome.

Individuals with Tourette syndrome (TS) have poorer quality of life (QoL) than their peers, yet factors contributing to poor QoL in this population remain unclear. Research to date has predominantly focused on the impact of tics and psychiatric symptoms on QoL in TS samples. The aim of this cross-sectional, multi-informant study was to identify psychosocial variables that may impact adolescent QoL in TS. Thirty-eight adolescents aged 13 to 17 with TS and 28 age-matched controls participated with a caregiver. No group differences were found on QoL, although the TS group reported reduced QoL compared to population normative data. In the TS group, reduced QoL was associated with lower self-esteem, poorer family functioning, higher stress, and greater depression and anxiety; QoL was unrelated to tic severity. In regression analyses, after adjusting for covariates, family functioning was the strongest predictor of QoL. These results emphasize the need to further explore the influence of psychosocial factors, particularly family functioning, on QoL in adolescents with TS.

HIV Stigma in Prisons and Jails: Results from a Staff Survey.

With numerous HIV service gaps in prisons and jails, there has been little research on HIV stigma attitudes among correctional staff. Such attitudes may undermine HIV services for inmates at risk of or infected with HIV. This HIV stigma attitudes survey among 218 correctional staff in 32 US facilities (1) provides an overview of staff's stigma attitudes, (2) reports psychometric analyses of domains in Earnshaw and Chaudoir's HIV Stigma Framework (HSF), and (3) explores differences in stigma attitudes among different staff types. Overall, correctional and medical staff expressed non stigmatizing attitudes toward people living with HIV/AIDS, but perceived that stigma and discrimination exist in others. Factor analyses revealed a three factor structure capturing two mechanisms of the HSF (prejudice, discrimination). Few factor score differences were found by staff type or setting. Implications for correctional HIV services and future research on HIV stigma attitudes are discussed.

Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial.

OBJECTIVE: Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT). METHODS: This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups. RESULTS: ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ2 = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ2 = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP. CONCLUSION: A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.

Treating substance use disorders in the criminal justice system.

The large number of individuals with substance use disorders involved in the nation's criminal justice system (CJS) represents a unique opportunity, as well as challenges, in addressing the dual concerns of public safety and public health. Unfortunately, a low proportion of those who could benefit from treatment actually receive it while involved in the CJS. This article presents a review of recent research on the effectiveness of major substance abuse treatment interventions used at different possible linkage points during criminal justice case processing, including diversion, jail, prison, and community supervision. This is followed by a discussion of key research and practice issues, including low rates of treatment access and under-utilization of medication-assisted treatment. Concluding comments discuss principles of effective treatment for offenders and identify key gaps in research and practice that need to be addressed to improve and expand provision of effective treatment for offenders.

PREDICTING RECIDIVISM FOR RELEASED STATE PRISON OFFENDERS: Examining the Influence of Individual and Neighborhood Characteristics and Spatial Contagion on the Likelihood of Reincarceration.

We examined the influence of individual and neighborhood characteristics and spatial contagion in predicting reincarceration on a sample of 5,354 released Pennsylvania state prisoners. Independent variables included demographic characteristics, offense type, drug involvement, various neighborhood variables (e.g., concentrated disadvantage, residential mobility), and spatial contagion (i.e., proximity to others who become reincarcerated). Using geographic information systems (GIS) and logistic regression modeling, our results showed that the likelihood of reincarceration was increased with male gender, drug involvement, offense type, and living in areas with high rates of recidivism. Older offenders and those convicted of violent or drug offenses were less likely to be reincarcerated. For violent offenders, drug involvement, age, and spatial contagion were particular risk factors for reincarceration. None of the neighborhood environment variables were associated with increased risk of reincarceration. Reentry programs need to particularly address substance abuse issues of ex-offenders as well as take into consideration their residential locations.

A 14-year-old Girl with Right-Sided Weakness and Speech Difficulty.

We herein report a case of Childhood Primary Central Nervous System (CNS) Angiitis. This case consisted of a 14-year-old girl who presented with right-sided weakness, aphasia, and a fever. A Magnetic Resonance Imaging of the brain showed multifocal areas of ischemia. Magnetic Resonance Angiography of the head and neck showed narrowing and irregularities of the left middle cerebral artery and right posterior cerebral artery. Cerebrospinal Fluid studies showed a lymphocytic pleocytosis and brain biopsy revealed leptomeningeal and perivascular inflammation. The epidemiology, presenting symptoms, work-up, pathophysiology, diagnostic criteria, and treatment of Childhood Primary CNS angiitis are discussed. This case serves as a reminder that when pediatric patients present with stroke-like symptoms inflammatory etiologies including Primary CNS Angiitis must be considered and treated appropriately in a time sensitive manner.

The Impact of Juvenile Drug Treatment Courts on Substance Use, Mental Health, and Recidivism: Results from a Multisite Experimental Evaluation.

Juvenile Drug Treatment Courts (JDTC) emerged in the mid-1990s as a potential solution to concern about substance use among youth in the juvenile justice system (JJS). Despite substantial research, findings on the JDTC effectiveness for reducing recidivism and substance use remain inconsistent, hampered by methodological problems. In 2016, the Office of Juvenile Justice and Delinquency Prevention published research-based JDTC Guidelines for best practices, and funded technical assistance for implementation and a multisite national outcomes study among JDTCs implementing the Guidelines. Ten sites were originally selected for this study, with a JDTC and Traditional Juvenile Court (TJC) participating. In two sites, moderate- to high-risk youth were randomized to JDTC or TJC, and in eight sites, a regression discontinuity design assigned moderate- to high-risk youth to JDTC, and other youth to TJC. Findings from four sites with sufficient cases and follow-up rates indicated that JDTCs reduced cannabis use, increased access to mental health services, and reduced recidivism. However, the effects were small to moderate, with positive impacts mainly observed among high-risk youth. The impacts of JDTCs may have been attenuated because Guidelines implementation was inconsistent across courts, and some TJCs implemented elements of the Guidelines, blurring the distinction between JDTCs and TJCs.

The impact of Juvenile Drug Treatment Courts (JDTC) implementing Federal Evidence-Based Guidelines on recidivism and substance use: multisite Randomized Controlled Trial (RCT) and Regression Discontinuity (RDD) Designs.

BACKGROUND: Juvenile drug treatment courts (JDTC) have struggled to define themselves since their inception in 1995. Early courts followed a format similar to adult drug courts, but these did not address the unique needs of juveniles, which led to the creation of 16 Strategies by a consensus panel of practitioners and researchers. But, like the first JDTCs, research with courts following these strategies failed to provide convincing evidence that this "model" was associated with significant reductions in recidivism or drug use. More recently, a new set of evidence-based guidelines were developed through meta-analyses commissioned by the Office of Juvenile Justice and Delinquency Prevention (OJJDP, 2016). METHOD: OJJDP provided funding for a rigorous multi-site evaluation of the guidelines. This study protocol paper for the Juvenile Drug Treatment Court (JDTC) Guidelines Cross-Site Evaluation presents research designs for the comparison of youth outcomes from 10 JDTCs compared with 10 Traditional Juvenile Courts (TJCs) in the same jurisdictions. Two sites opted into a randomized controlled trial (RCT) and eight sites chose to follow a regression discontinuity design (RDD). Youth data are captured at baseline, and at 6- and 12-month follow-ups using an interview comprised of several standardized assessments. The youths' official records also are abstracted for recidivism and substance use information. The degree to which the evidence-based guidelines are implemented at each site is assessed via an in-depth court self-assessment collected at baseline and again 2 years later and via structured site visits conducted once during implementation. DISCUSSION: As a field-based trial, using both RCT and RDD designs, findings will provide important, policy-relevant information regarding the implementation of the OJJDP evidence-based guidelines, including the degree to which JDTCs adopted and/or modified these practices, their relative impact on recidivism and substance use, as well as the degree to which JDTCs differ from TJCs. Specific inferences may be drawn about whether following or not following specific guidelines differentially impact youth outcomes, yielding recommendations about the translation of this information from research-to-practice for potentiating the broader adoption of these guidelines by JDTCs nationwide. CLINICAL TRIALS REGISTRATION: This was not an NIH supported trial. The funder, OJJDP/NIJ, instead required publishing the design with even more information at https://www.ojp.gov/ncjrs/virtual-library/abstracts/juvenile-drug-treatment-court-jdtc-guidelines-cross-site-evaluation .

Effectiveness of Suicide-Focused Psychosocial Interventions in Psychosis: A Systematic Review and Meta-Analysis.

OBJECTIVE: Suicide ideation, plan, attempt, and death are significant and prevalent concerns among individuals with psychosis. Previous studies have focused on risk factors, but few have systematically evaluated the effect of psychosocial interventions on these experiences among individuals with psychosis. This study evaluated the effectiveness of psychosocial interventions in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. METHODS: Eight electronic databases were systematically searched from inception until June 30, 2019. Identified studies included both randomized controlled trials and controlled trials without randomization that examined psychosocial interventions for suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. A random-effects model was used to pool the effect sizes for synthesis. RESULTS: Eleven studies with 14 effect sizes (N=4,829 participants) were analyzed. The average age of participants ranged from 21 to 51, and most participants identified as male and non-Hispanic Caucasian or Chinese and were in an early or first-episode stage of illness. On average, participants who received psychosocial interventions were less likely than their counterparts in the control group to report suicide ideation, plan, and attempt and die by suicide (odds ratio [OR]=0.57, 95% confidence interval [CI]=0.41-0.78). Subgroup analyses further revealed significant reductions in suicide ideation (OR=0.73, 95% CI=0.55-0.97) and suicide death (OR=0.45, 95% CI=0.30-0.68) among intervention participants. CONCLUSIONS: Preliminary evidence indicated that psychosocial interventions are effective in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. Intervention characteristics, however, varied across studies, which suggests a lack of consensus on best clinical practices.

Problem severity and motivation for treatment in incarcerated substance abusers.

Studies of community-based treatment programs for substance users document that motivation for treatment is a consistent predictor of clients remaining under treatment for a longer period of time. Recent research has replicated this in prison-based treatment programs, implying that motivation is clinically important regardless of setting. The current study examines predictors of treatment motivation using data collected from 661 male drug-involved inmates during in-depth interviews that include components of the Addiction Severity Index, TCU Motivation Scale, and the Heath Services Research Instrument. Findings showed treatment motivation can be measured effectively in prison-based settings. Motivation scores were not significantly different between individuals in a prison-based treatment program and those in the general prison population. Furthermore, higher motivation for treatment scores were associated with greater levels of problem severity, suggesting that individuals with more drug-use related life problems may recognize this need and desire help for beginning long-term recovery.

Rural Location and Relative Location: Adding Community Context to the Study of Sexual Assault Survivor Time Until Presentation for Medical Care.

Despite a strong empirical base linking community context and proximity to resources to individual health care access, studies examining predictors of sexual assault survivor time until presentation for medical care have not yet examined these relationships. This study addresses this gap. The data included retrospective records on a sample of 1,630 female survivors who reported their sexual assault to law enforcement and were subsequently seen by a sexual assault nurse examiner (SANE) in one of eight Alaskan communities between the years 1996 and 2006. Logistic regression models were used to determine whether delays in presentation (presentation 12 hr or more after assault) differed for women presenting in unique communities (rural location), and between those whose assault and exam occurred in different communities versus occurring in the same community (relative location). Although rural location did not seem to have a unique impact on time until presentation, differing locations (i.e., relative location) of assaults and exams increased the likelihood of delays in presentation. Non-American Indian/Alaska Native race/ethnicity and knowing one's assailant(s) also increased the likelihood of delays. These results indicate that in addition to a need for further research, there is a need for more appropriate and reliable sexual assault medical services across communities, and that survivors assaulted by known assailants should be targeted in efforts to reduce time until presentation.

A Survey About Fever Knowledge, Attitudes, and Practices Among Parents.

A 21-question survey was conducted among parents attending 4 pediatric outpatient practices to assess their knowledge, perceptions, and attitudes about fever. One hundred and ninety-seven surveys were included. Most commonly the participating parent was the mother. Parents used mainly axillary thermometers to measure child's temperature and mentioned integers for their definition of fever, 100°F being the most frequent answer. Most parents would treat all fevers and would use alternating antipyretics. Parents had a generally negative perception of fever: only one third thought fever may have some benefit, and more than half thought there must be some risk. A positive perception of fever was associated with parental educational level but not with information by the pediatrician. There is much confusion about fever among our parents, a negative perception is prevalent, and parents seem to receive-or recall-little information from the pediatrician.

Mental Health Risk Factors and Parole Decisions: Does Inmate Mental Health Status Affect Who Gets Released.

Parole decision-the decision to release an incarcerated individual from prison conditionally-is one of the most critical decisions across justice systems around the world. The decision carries with it significant consequences: for the freedom of the individual awaiting release (the parolee); for the safety of the community in which they will return; and for the correctional system overall, especially its organizational capacity. The current study attempts to add to the parole decision-making literature by specifically analyzing the role that mental health factors may play in explaining parole decisions. Research to date is inconclusive on whether or not mental illness is a risk factor for criminal behavior; despite this, individuals with mental health problems generally fare worse on risk assessment tools employed in justice decisions. The study relies on a 1000+ representative sample of parole-eligible individuals in Pennsylvania, United States. To increase reliability, the analyses test for several mental health factors based on information from different sources (i.e., self-reported mental health history; risk assessment tool employed by the Parole Board; and risk assessment tool employed by the Department of Corrections). To address validity concerns, the study controls for other potential correlates of parole decisions. Although the multivariate models explained a considerable amount of variance in parole decisions, the inclusion of mental health variables added relatively little to model fit. The results provide insights into an understudied area of justice decision making, suggesting that despite the stigmatization of mental illness among criminal justice populations, parole board members in Pennsylvania, United States, appear to follow official guidelines rather than to consider more subjective notions that poor mental health should negate parole release.

National Survey of Juvenile Community Supervision Agency Practices and Caregiver Involvement in Behavioral Health Treatment.

OBJECTIVES: This study sought to expand the sparse literature examining the extent to which family engagement interventions and the structural characteristics of juvenile community supervision agencies influence caregiver participation in youths' behavioral health (i.e., mental health and substance use) treatment. METHODS: We analyzed data from a national survey of juvenile community supervision agencies, conducted as a part of a Juvenile Justice Translational Research on Interventions for Adolescents in the Legal System (JJTRIALS) Cooperative Agreement funded by NIH/NIDA. RESULTS: Findings indicated agencies employ a variety of family engagement strategies, with passive strategies like services referrals and flexible schedules being more common than active strategies like provision of family therapy. Multivariate prediction of caregiver involvement in behavioral health care showed the most consistent effects for rural-urban location of the agency; rural agencies more successfully engaged families in their youth's behavioral healthcare. Relatedly, the more family engagement services, the greater the involvement of families in behavioral health treatment. Agencies with a juvenile drug treatment court also showed greater involvement. CONCLUSIONS: Our findings that juvenile justice agencies are using multiple techniques to engage families, and that there is a relationship between use of these techniques and actual family engagement, would benefit from replication over time and in other jurisdictions. Analysis of data from a second wave of the national survey, recently completed, is expected to test the reliability of our findings over time, as well as identify whether and what kind of changes occurred in the two years following the first survey.

A model for rigorously applying the Exploration, Preparation, Implementation, Sustainment (EPIS) framework in the design and measurement of a large scale collaborative multi-site study.

BACKGROUND: This paper describes the means by which a United States National Institute on Drug Abuse (NIDA)-funded cooperative, Juvenile Justice-Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS), utilized an established implementation science framework in conducting a multi-site, multi-research center implementation intervention initiative. The initiative aimed to bolster the ability of juvenile justice agencies to address unmet client needs related to substance use while enhancing inter-organizational relationships between juvenile justice and local behavioral health partners. METHODS: The EPIS (Exploration, Preparation, Implementation, Sustainment) framework was selected and utilized as the guiding model from inception through project completion; including the mapping of implementation strategies to EPIS stages, articulation of research questions, and selection, content, and timing of measurement protocols. Among other key developments, the project led to a reconceptualization of its governing implementation science framework into cyclical form as the EPIS Wheel. The EPIS Wheel is more consistent with rapid-cycle testing principles and permits researchers to track both progressive and recursive movement through EPIS. Moreover, because this randomized controlled trial was predicated on a bundled strategy method, JJ-TRIALS was designed to rigorously test progress through the EPIS stages as promoted by facilitation of data-driven decision making principles. The project extended EPIS by (1) elucidating the role and nature of recursive activity in promoting change (yielding the circular EPIS Wheel), (2) by expanding the applicability of the EPIS framework beyond a single evidence-based practice (EBP) to address varying process improvement efforts (representing varying EBPs), and (3) by disentangling outcome measures of progression through EPIS stages from the a priori established study timeline. DISCUSSION: The utilization of EPIS in JJ-TRIALS provides a model for practical and applied use of implementation frameworks in real-world settings that span outer service system and inner organizational contexts in improving care for vulnerable populations. TRIAL REGISTRATION: NCT02672150 . Retrospectively registered on 22 January 2016.

Predictors of substance abuse treatment entry for crime-involved, cocaine-dependent women.

A health services utilization model was used to examine predictors of treatment entry among a large sample (N=659) of crime-involved, cocaine-dependent women. Previous research in this area has focused on women already in treatment and resultantly excluded a critical population of drug-dependent women who are actively using but not in treatment. Thus, interviews were completed with women who were participating in substance abuse treatment programs and with women who were not currently in treatment to examine what factors may have inhibited or facilitated their entering treatment. The predisposing characteristics, enabling resources, and service needs of these women were assessed in relation to their treatment utilization status. Findings indicated that variables within each of the three categories of the health services model were related to treatment entry including race/ethnicity and education (predisposing characteristics), and alcohol use and having multiple chronic health problems (need). But, overall, enabling factors, such as being legally employed, having health insurance, having custody of children, and knowing where to go to get treatment, appeared to be the most influential predictors. Implications of this research include employing multiple tactics for increasing the likelihood of treatment entry such as aggressive outreach efforts focusing on at-risk women who have the fewest social ties and who are the least integrated into mainstream society.

Client outcomes from rural substance abuse treatment.

Several national evaluations have been conducted since the late 1960s that have assessed the effectiveness of publicly-funded substance abuse treatment in the United States. These studies, however, have focused principally on urban-based treatment programs, and it is unclear whether findings from urban programs can be replicated in outcome studies of programs in rural areas. The current study, therefore, examined the treatment outcomes of clients admitted to one of several short-term inpatient or outpatient drug-free treatment agencies in rural Kentucky. Findings showed that treatment was associated with reductions in drug use and criminality during a six-month follow-up interval. Employment status also improved significantly, and health services utilization was reduced. The similarity between the current findings and findings from national outcome studies of urban-based treatment programs is discussed.

A prospective examination of high-cost health services utilization among drug using prisoners reentering the community.

The use of health services by prisoners during their incarceration and after their return to the community impacts the U.S. health care system and health care costs associated with this system. These health care costs are expected to increase over the next decade as more prisoners return to their communities. The current study prospectively examines the use of high-cost health care services-emergency room visits and hospitalizations-among 565 male drug-abusing prisoners about 1 year after prison release. A series of structural equation models were used to examine predisposing factors, including health status and drug use, and to estimate the frequency of high-cost health service utilization. As expected, health status was the most robust predictor of high-cost health services. However, the finding that drug abuse had nonsignificant relationships with high-cost health services utilization was not expected. Discussion focuses on health care service issues and health problems as prisoners' transition from prison to the community.

Correlates of subjective stress among drug court clients.

Psychosocial stress is consistently found to promote initiation, intensification, and relapse in drug abuse. It would, therefore, be desirable to identify characteristics of offenders who are at heightened risk for stress-induced exacerbations of addictive behavior. In this cross-sectional, correlational, interview study, 500 clients of two Kentucky drug courts averaged 30 years of age and were predominantly male, White, employed, high school educated, single, and adjudicated in small- and medium-size cities. Five independent correlates of greater subjective stress emerged in stepwise multiple regression analysis (R2 = .395): use of escape-avoidance coping, positive reappraisal coping (inversely associated), more negative life events, better self-rated health (inversely associated), and access to social support related to work problems (inversely associated). Treatment interventions emphasizing effective coping styles and building of social support as well as managing of negative life events and perceptions of health may serve to lessen subjective stress and its consequences in drug-abusing criminal populations.

Efficacy of a Process Improvement Intervention on Inmate Awareness of HIV Services: A Multi-Site Trial.

The prevalence of HIV among U.S. inmates is much greater than in the general population, creating public health concerns and cost issues for the criminal justice system. The HIV Services and Treatment Implementation in Corrections protocol of the NIDA funded Criminal Justice Drug Abuse Treatment Studies cooperative tested the efficacy of an organizational process improvement strategy on improving HIV services in correctional facilities. For this paper, we analyzed efficacy of this strategy on improving inmate awareness and perceptions of HIV services. The study used a multi-site (n=28) clustered randomized trial approach. Facilities randomized to the experimental condition used a coach-driven local change team approach to improve HIV services at their facility. Facilities in the control condition were given a directive to improve HIV services on their own. Surveys about awareness and perceptions of HIV services were administered anonymously to inmates who were incarcerated in study facilities at baseline (n=1253) and follow-up (n=1048). A series of one-way ANOVAs were run to test whether there were differences between inmates in the experimental and control facilities at baseline and follow-up. Differences were observed at baseline, with the experimental group having significantly lower scores than the control group on key variables. But, at post-test, following the intervention, these differences were no longer significant. Taken in context of the findings from the main study, these results suggest that the change team approach to improving HIV services in correctional facilities is efficacious for improving inmates' awareness and perceptions of HIV services.