Relationships between hope, optimism, and conservation engagement.

The loss and degradation of nature can lead to hopelessness and despair, which may undermine engagement in conservation actions. Emerging movements, such as that behind the organization Conservation Optimism, aim to avert potential despair of those involved in conservation. Some argue that fostering positive states, such as hope or optimism, can motivate engagement and action; however, others question whether fostering hope or optimism may inadvertently undermine perceived gravity of conservation challenges. We examined this issue by quantifying dispositional hope and optimism with a representative sample of Australians (n = 4285) and assessing their relationship with indicators of conservation engagement. We used the Great Barrier Reef (GBR) in Australia as a case study. We asked participants what they could do to help the GBR, then classified their responses into 2 outcome variables: identifying climate actions (i.e., actions that tackle the main threat to the reef) and identifying plastic actions (i.e., actions that are popular among community members). We also quantified likelihood of performing these actions and appraisals of both threats and actions. One dimension of hope, hope pathways (defined by Snyder's hope theory as knowing different ways to act), was associated with greater capacity to identify climate-related behaviors (odds ratio [OR] = 1.44) and plastic reduction behaviors (OR = 1.22) and greater likelihood of adopting climate-related actions (ß = 0.20). Optimism was associated with recognition of plastic reduction behaviors only (OR = 1.22). Neither hope nor optimism undermined appraisal of conservation threats. The effects of optimism were mediated by reduced action futility, and effects of hope pathways were mediated by stronger perceptions of threats to the reef (threat appraisal) and confidence in performing useful actions (coping appraisal). Our findings suggest that dispositional hope can strengthen, rather than undermine, appraisal of conservation challenges and solutions and thereby increase conservation engagement.

La pérdida y la degradación de la naturaleza pueden derivar en desesperanza y desesperación, las cuales pueden disminuir la participación en las actividades de conservación. Los movimientos, como aquél detrás de la organización Conservation Optimism, buscan evitar la potencial desesperación de aquellos involucrados en la conservación. Hay quienes argumentan que promover estados positivos, como la esperanza y el optimismo, puede debilitar inadvertidamente la gravedad percibida de los retos para la conservación. Analizamos este tema mediante la cuantificación de la disposición a la esperanza y el optimismo en una muestra representativa de australianos (n = 4285) y la valoración de sus relaciones con los indicadores de participación en la conservación. Usamos la Gran Barrera de Arrecife como un estudio de caso. Preguntamos a los participantes qué podrían hacer para ayudar a este ecosistema y después clasificamos sus respuestas en dos variables de resultado: identificar acciones climáticas (acciones que combaten la amenaza principal del arrecife) e identificar acciones plásticas (acciones que son populares entre los miembros de la comunidad). También cuantificamos la probabilidad de realizar estas acciones y las valoraciones tanto de las amenazas como de las acciones. Una dimensión de la esperanza, los caminos de la esperanza (definidas por la Teoría de la Esperanza de Snyder como saber actuar de diferentes maneras), estuvo asociada con una mayor capacidad para identificar los comportamientos relacionados con el clima (razón de oportunidades [OR]=1.44) y aquellos de reducción del plástico (OR = 1.22) y también con una mayor probabilidad de actuar en relación con el clima (ß = 0.20). El optimismo solamente estuvo asociado con el reconocimiento de los comportamientos de reducción del plástico (OR = 1.22). Ni el optimismo ni la esperanza debilitaron la valoración de las amenazas a la conservación. Los efectos del optimismo estuvieron mediados por la reducción de la futilidad de las acciones, mientras que los efectos de los caminos de la esperanza lo estuvieron por percepciones más firmes de las amenazas para el arrecife (valoración de amenazas) y la confianza en realizar acciones útiles (valoración del afrontamiento). Nuestros resultados sugieren que la disposición a la esperanza puede fortalecer, en lugar de debilitar, la valoración de la conservación y, por lo tanto, incrementar su participación.

Environmental Management in the Peri-urban Region: Psychological and Contextual Factors Influencing Private Land Conservation Actions.

Peri-urban areas, defined as the region between urban and rural settlements, are heterogeneous, dynamic regions experiencing rapid land use change in cities around the world. Ongoing development and land use change has resulted in the fragmentation, degradation and loss of natural assets, threatening biodiversity, and ecosystems within the peri-urban region. With much of this land privately owned, the actions of landholders have considerable opportunity to deliver environmental outcomes, yet an understanding of this diverse group of landholders is challenging. Through a survey of landholders (N = 184) in Australian peri-urban regions we sought to understand motivations and barriers to engagement in environmental management. Factors influencing willingness to engage in environmental management included perceived personal capacity to act, feeling that actions were helpful, and community participation. We discuss how engagement strategies could incorporate these findings by focussing on improving capacity and environmental knowledge with hands on, face-to-face extension activities, encouraging simple actions, and fostering greater community interaction.

Achieving conservation impact by shifting focus from human attitudes to behaviors.

Attitudes have been a commonly used psychological measure of program effectiveness in conservation social science research. The major limitation of this approach is that attitudes do not always translate into behavior and therefore may not provide an accurate assessment of program success. Given that achieving conservation goals generally relies on understanding and changing human behavior, we argue for the need to assess behavior rather than attitudes as an indicator of conservation outcomes. Psychological theory shows that attitudes and behavior are distinct, but related, concepts. Measuring conservation behaviors involves identifying the target behavior or behaviors and the optimal time to measure and then selecting the most appropriate method of measurement (i.e., direct observation, objective indicators, self-reported behavior, and behavioral intentions) that considers the strengths and weaknesses of each approach. We call for conservation programs to focus on influencing behavior rather than attitudes alone and encourage conservation practitioners and researchers to collect high-quality behavioral data to more effectively inform policy and programs.

Logro del Impacto de la Conservación Cambiando el Enfoque en las Actitudes Humanas a los Comportamientos Resumen Las actitudes han sido utilizadas comúnmente como una medida psicológica de la eficacia de una investigación de ciencias sociales de la conservación. La principal limitación de este enfoque es que las actitudes no siempre se traducen en comportamiento y, por lo tanto, pueden no proporcionar una evaluación precisa del éxito del programa. Dado que el logro de los objetivos de conservación generalmente se basa en la comprensión y el cambio del comportamiento humano, argumentamos la necesidad de evaluar el comportamiento en lugar de las actitudes como un indicador de los resultados de conservación. La teoría psicológica muestra que las actitudes y el comportamiento son conceptos distintos, pero relacionados. La medida de comportamientos de conservación implica la identificación del comportamiento o los comportamientos buscados y del tiempo óptimo para medirlos y luego seleccionar el método de medición más apropiado (i. e., observación directa, indicadores objetivos, comportamiento auto reportado e intenciones de comportamiento) que considere las fortaleza y debilidades de cada enfoque. Hacemos un llamado para que los programas de conservación se centren en influir en el comportamiento en lugar de las actitudes por sí solas y alentamos a que los profesionales e investigadores de la conservación recopilen datos conductuales de calidad para que las políticas y programas tengan información eficaz.

Landholder typologies illuminate pathways for social change in a deforestation hotspot.

Psychosocial factors determine individual and collective behaviours, and there is growing evidence of their influence on land management behaviours. Native vegetation management encompasses biophysical, economic, political, and cultural dimensions that are immensely complex, and a more thorough understanding of the personal and cultural dimensions of deforestation activity is required. We emphasise this interdisciplinary imperative using Queensland, Australia, as an exemplar case study, where the controversial Vegetation Management Act1999 has been met with significant scrutiny over its effects on private landholders and its ability to curb deforestation behaviours. We surveyed landholders across Queensland in order to identify different landholder typologies based upon (1) their recent tree clearing behaviours and (2) their psychosocial characteristics, mapped their distribution in the landscape, and determined the unique demographic and psychosocial factors associated with typology membership. We identified a heterogeneous mosaic of landholders in the clearing landscape, composed of four clearing typologies and five psychosocial typologies. Social norms, identity, trust, and security played crucial roles in distinguishing different types of landholders. The two most contrasting clearing typologies-active and inactive clearers-were primarily located in hot- and cold-spots of deforestation, respectively; in contrast, most psychosocial typologies could be found throughout the landscape, highlighting the potential benefit of complementing generalised state-wide psychosocial targets with localised behavioural targets. We discuss how conservation policy instruments can be regionally tailored, and relevant strategies for effective communication and engagement can be developed to create behaviour change by understanding the characteristics and distribution of these types of landholders. If modified top-down efforts (e.g. strategic messages, community-based communication) can be supplemented with more bottom-up approaches (e.g. collective learning, building network support), sustainable land management in deforestation hotspots around the world may be achievable.

Program Awareness, Social Capital, and Perceptions of Trees Influence Participation in Private Land Conservation Programs in Queensland, Australia.

Voluntary private land conservation (PLC) is becoming an increasingly important complement to state protected areas around the world. PLC programs can serve as valuable strategies to increase biodiversity on agricultural lands, but their effectiveness depends on high participation rates. Amidst growing concerns regarding scalability and effectiveness of conservation strategies like national parks, researchers and practitioners are looking for new strategies to increase adoption of PLC. This study investigates the demographic, social, and psychological factors associated with participation in three classes of voluntary PLC programs-grant payments, land management agreements, and covenants-and how this relates to landholders' attitudes toward tree clearing. We compare participation rates between these programs in Queensland and identify the most frequently cited reasons why land managers have or have not participated. Land managers who are more involved in agricultural organizations and whose tree clearing decisions are more influenced by the aesthetic value of trees are more likely to have participated in one or more of these programs. Participation was highly biased toward once-off grant payments, and participation in covenants was lowest of all programs. Although 58% of land managers have never participated, nearly half expressed interest in one or more programs. A lack of program knowledge and perceived losses of autonomy were the most frequently cited barriers to participation. We conclude with recommendations for increasing participation rates and raise important questions that need to be answered in order to promote a PLC culture that effectively curbs ongoing habitat degradation.

How do marine and coastal citizen science experiences foster environmental engagement?

Citizen science programs enable community involvement in scientific research. In addition to fostering greater science literacy, some citizen science programs aim to foster engagement in environmental issues. However, few data are available to indicate whether and how citizen science programs can achieve greater environmental engagement. We survey individuals choosing to attend one of seventeen reef citizen science events and examine the extent to which attendees reported three indicators of greater environmental engagement: (i) willingness to share information, (ii) increased support for marine conservation and citizen science, and (iii) intentions to adopt a new behavior. Most participants reported being willing to share information about reef conservation (91%) and described increased support for marine science and conservation (87%). Half of participants (51%) reported intentions to adopt a new conservation behavior. We found that key elements of the citizen science experience associated with these outcomes were learning about actions to protect reefs and coasts (procedural learning), experiencing surprise, and experiencing negative emotions about environmental problems. Excitement was also associated with positive outcomes, but only in participants who were less likely to see themselves as environmental, or were less frequent visitors to reefs and coasts. Importantly, the association between factual learning and environmental engagement outcomes was limited or negative. These findings suggest that the way citizen science experiences make people feel, may be more important for fostering future environmental engagement than factual-based learning. When designing citizen science programs for community members, these findings provide a reminder to not focus on provision of factual information alone, but to highlight environmental impacts while providing meaningful experiences and building environmental skills.

Advocating for malaria elimination - learning from the successes of other infectious disease elimination programmes.

Malaria elimination is back on the agenda, but it remains challenging for countries to make the transition from effective control to elimination. Many other infectious diseases have been targeted by globally-coordinated elimination advocacy campaigns, and advocacy has been considered an essential component of the success of other disease elimination programmes. What can the malaria community learn from these successes? A review of infectious disease elimination programmes to identify successful elements of advocacy for disease elimination was undertaken. Key elements are: (i) a global elimination plan, supported by international health bodies; (ii) thorough costings and tools to support the business case; (iii) an approach that is positioned within a development framework; (iv) core elimination advocacy messages; (v) provision of advocacy tools for partners (vi) extensive and effective community engagement; and (vii) strong partnerships. These features provide insights into 'what works' in global elimination advocacy. Advocacy is a powerful tool to support the long-term political and financial commitment necessary for malaria elimination. The global malaria community needs to work together, to ensure that the early steps towards the end goal of malaria elimination are taken.

Are child and adolescent mental health problems increasing in the 21st century? A systematic review.

OBJECTIVE: Up to one in five children experience mental health problems. Social and cultural factors may influence emergence of mental health problems. The 21st century has led to changes in many of these factors, but it is unclear whether rates of internalizing and externalizing problems have also changed in recent cohorts of young people. METHODS: A comprehensive literature search was undertaken to locate cohort or population studies that examined changes in mental health of children over time, where participants were aged 18 years and under, and the time frame for change was at least 10 years, with data for at least one time point in the 21st century being statistically compared to at least one time point in the 20th century. Studies were reviewed for quality and outcome. RESULTS: Nineteen studies met criteria for review. These included studies of toddlers, children, and adolescents. Seventeen studies examined internalizing problems, and 11 studies examined externalizing problems. For both children and toddlers, recent cohorts did not exhibit worsening of mental health symptoms. In adolescents, the burden of externalizing problems appear to be stable. However, the majority of studies report an increase in internalizing problems in adolescent girls. The findings for internalizing problems in boys were mixed. CONCLUSIONS: These findings suggest that recent cohorts of adolescent girls are experiencing increases in internalizing symptoms compared to previous cohorts. Approaches for prevention and early intervention should be explored.

Use of restrictive interventions in a child and adolescent inpatient unit - predictors of use and effect on patient outcomes.

OBJECTIVES: Restrictive interventions (seclusion, physical restraint, and use of acute/p.r.n. sedation) may have negative effects on patients. Identifying factors associated with use of restrictive interventions and examining their effect on admission outcomes is important for optimising inpatient psychiatric care. METHODS: This study documented use of restrictive interventions within a child and adolescent psychiatric inpatient unit for 15 months. Two models examined predictors of use of restrictive interventions: (i) incident characteristics; and (ii) patient characteristics. The relationship between use of restrictive interventions and global clinical outcomes was also examined. RESULTS: Of 134 patients admitted during the study period (61.9% female, mean age=13.8±2.9 years), 26.9% received at least one restrictive intervention. Incident factors associated with restrictive interventions were: physical aggression, early admission stage, and occurrence in private space. Patient factors that predicted use of restrictive interventions were developmental disorder and younger age. Use of restrictive interventions was not associated with increased length of stay or diminished improvement in global symptom ratings. CONCLUSIONS: Further research is needed to identify best practice in children at high risk for receiving restrictive interventions.

Dopamine D2 receptor modulation of human response inhibition and error awareness.

Response inhibition, comprising action cancellation and action restraint, and error awareness are executive functions of considerable clinical relevance to neuropsychiatric disorders. Nevertheless, our understanding of their underlying catecholamine mechanisms, particularly regarding dopamine, is limited. Here, we used the dopamine D2 agonist cabergoline to study its ability to improve inhibitory control and modulate awareness of performance errors. A randomized, double-blind, placebo-controlled, crossover design with a single dose of cabergoline (1.25 mg) and placebo (dextrose) was employed in 25 healthy participants. They each performed the stop-signal task, a well-validated measure of action cancellation, and the Error Awareness Task, a go/no-go measure of action restraint and error awareness, under each drug condition. Cabergoline was able to selectively reduce stop-signal RT, compared with placebo, indicative of enhanced action cancellation (p < .05). This enhancement occurred without concomitant changes in overall response speed or RT variability and was not seen for errors of commission on the Error Awareness Task. Awareness of performance errors on the go/no-go task was, however, significantly improved by cabergoline compared with placebo (p < .05). Our results contribute to growing evidence for the dopaminergic control of distinct aspects of human executive ability, namely, action cancellation and error awareness. The findings may aid the development of new, or the repurposing of existing, pharmacotherapy that targets the cognitive dysfunction of psychiatric and neurological disorders. They also provide further evidence that specific cognitive paradigms have correspondingly specific neurochemical bases.

The role of incentive mechanisms in promoting forest restoration.

Forest restoration has been proposed as a scalable nature-based solution to achieve global environmental and socio-economic outcomes and is central to many policy initiatives, such as the Bonn Challenge. Restored forests contain appreciable biodiversity, improve habitat connectivity and sequester carbon. Incentive mechanisms (e.g. payments for ecosystem services and allocation of management rights) have been a focus of forest restoration efforts for decades. Yet, there is still little understanding of their role in promoting restoration success. We conducted a systematic literature review to investigate how incentive mechanisms are used to promote forest restoration, outcomes, and the biophysical and socio-economic factors that influence implementation and program success. We found that socio-economic factors, such as governance, monitoring systems and the experience and beliefs of participants, dominate whether or not an incentive mechanism is successful. We found that approximately half of the studies report both positive ecological and socio-economic outcomes. However, reported adverse outcomes were more commonly socio-economic than ecological. Our results reveal that achieving forest restoration at a sufficient scale to meet international commitments will require stronger assessment and management of socio-economic factors that enable or constrain the success of incentive mechanisms. This article is part of the theme issue 'Understanding forest landscape restoration: reinforcing scientific foundations for the UN Decade on Ecosystem Restoration'.

Beyond ecology: ecosystem restoration as a process for social-ecological transformation.

Ecosystem restoration conventionally focuses on ecological targets. However, while ecological targets are crucial to mobilizing political, social, and financial capital, they do not encapsulate the need to: integrate social, economic, and ecological dimensions and systems approaches; reconcile global targets and local objectives; and measure the rate of progress toward multiple and synergistic goals. Restoration is better conceived as an inclusive social-ecological process that integrates diverse values, practices, knowledge, and restoration objectives across temporal and spatial scales and stakeholder groups. Taking a more process-based approach will ultimately enable greater social-ecological transformation, greater restoration effectiveness, and more long-lasting benefits to people and nature across time and place.

Predictors of medication adherence in children receiving psychotropic medication.

AIM: Medication adherence is poor in many young people with chronic illness. However, little research has examined medication adherence in clinic samples of young people receiving psychotropic medication, and whether factors such as disorder or drug type influence adherence. This study aimed to examine medication adherence in children and adolescents receiving psychotropic medication. METHODS: Young people receiving psychotropic medication and their caregivers were recruited from pharmacy and mental health services within a large metropolitan hospital. A brief cross-sectional survey examined medication history, missed doses within the previous week and other clinical information. Multiple regression analysis examined whether child characteristics, drug type and regimen characteristics were associated with medication adherence. RESULTS: Poor adherence was associated with lack of parental involvement in medication routines (P < 0.05), use of complementary medicines (P < 0.01) and difficulty remembering doses (P < 0.01). Developmental diagnoses (P < 0.05), use of antipsychotics (P < 0.05) and use of concomitant non-psychotropic medication (P < 0.05) were predictors of good adherence. CONCLUSION: Encouraging parental involvement in medication routines may be a practical target for clinicians aiming to improve medication adherence in young people. Use of complementary medicines may indicate a group with a higher risk of poorer adherence.

Heroin use, dependence, and attitudes to treatment in non-treatment-seeking heroin users: a pilot study.

Much research examining heroin users utilizes treatment samples; non-treatment-seeking heroin users are not well understood. It is unclear whether this group can avoid impaired control or negative sequelae commonly observed in treatment-seeking populations. During 2000 and 2001, we recruited 69 non-treatment-seeking heroin users with no treatment history. Heroin use, management strategies, treatment attitudes, and risk behaviors were assessed; the DSM-IV checklist and severity of dependence scale were completed. Study limitations and implications for heroin use and its treatment are discussed.

Psychosocial drivers of land management behaviour: How threats, norms, and context influence deforestation intentions.

Understanding how private landholders make deforestation decisions is of paramount importance for conservation. Behavioural frameworks from the social sciences have a lot to offer researchers and practitioners, yet these insights remain underutilised in describing what drives landholders' deforestation intentions under important political, social, and management contexts. Using survey data of private landholders in Queensland, Australia, we compare the ability of two popular behavioural models to predict future deforestation intentions, and propose a more integrated behavioural model of deforestation intentions. We found that the integrated model outperformed other models, revealing the importance of threat perceptions, attitudes, and social norms for predicting landholders' deforestation intentions. Social capital, policy uncertainty, and years of experience are important contextual moderators of these psychological factors. We conclude with recommendations for promoting behaviour change in this deforestation hotspot and highlight how others can adopt similar approaches to illuminate more proximate drivers of environmental behaviours in other contexts.

Understanding the effectiveness of policy instruments to encourage adoption of farming practices to improve water quality for the Great Barrier Reef.

Governments in Australia and internationally are experimenting with policy instruments to facilitate the adoption of farming practices with reduced environmental impacts. The Great Barrier Reef (Australia) is one such case, where sustained efforts over 20 years have yielded insufficient progress towards targets to reduce the impacts of agriculture on water quality in downstream marine ecosystems. We present a critical review of policy instruments as implemented in Great Barrier Reef catchments. We catalogue the evolving mix of policy instruments employed in reef programs, and examine evidence of the effectiveness of agricultural extension, financial incentives, and direct regulation of farming practices. There is little robust evidence to assess instrument effectiveness, in part due to the evolving mix of the instruments employed, weak program evaluation and heterogeneity of agricultural enterprises. We identify the need to improve the understanding of instrument fit to landholders and enterprises. We recommend a modelling approach to clarify pathways to impact and guide improved policy evaluation.

Exposure to aggression and the impact on staff in a child and adolescent inpatient unit.

Aggression is common in mental health services, but little research has examined exposure to aggression and its impact on staff in children and adolescent settings. Staff members within a child and adolescent psychiatric inpatient unit were interviewed to examine exposure to aggression and perceptions about the impact of aggression. Involvement in episodes of physical aggression was common (84.8%, 28/33) and was linked to difficulty attending work and other emotional and professional sequelae. These findings suggest that aggression is an important issue for staff working in child and adolescent settings and that aggression may impair the therapeutic capacity of staff.

Changing utilization of pro re nata ('as needed') sedation in a child and adolescent psychiatric inpatient unit.

OBJECTIVE: The primary purpose of the present study was to examine changes in utilization of pro re nata (PRN; 'as required') sedation over time within a child and adolescent psychiatric inpatient unit. The secondary purpose was to assess whether changes in PRN sedation were related to changing patient characteristics. METHODS: A retrospective chart review examined 257 medical charts from a child and youth mental health inpatient service over two time periods (wave I, n = 122; wave II, n = 135) and collected data on PRN sedation, patient characteristics and routine medications. RESULTS: Over time a significant reduction was observed in the proportion of patients prescribed PRN sedation from 70% to 54% (p < 0.01), and a reduction in the proportion of patients given PRN sedation from 46% to 26% (p < 0.01). The most commonly administered drug was chlorpromazine in wave I, and diazepam in wave II. Multivariate analysis indicated that reductions in PRN sedation occurred independently of changes in patient characteristics. CONCLUSIONS: High utilization rates of PRN sedation are not inevitable in a child and adolescent psychiatric inpatient unit and may be reduced over time. Changing utilization of PRN sedation occurred independently from changing patient characteristics. More treatment outcome studies are required to optimize use of PRN sedation in young people.

Determination of risperidone and 9-Hydroxyrisperidone using HPLC, in plasma of children and adolescents with emotional and behavioural disorders.

A simple, rapid, selective, accurate and precise method is described for the determination of risperidone and its active metabolite, 9-hydroxyrisperidone, in plasma using a chemical derivative of risperidone (methyl-risperidone) as the internal standard. The sample workup involved a single-step extraction of 1 mL plasma, buffered to pH 10, with heptane-isoamyl alcohol (98:2 v/v), then evaporation of the heptane phase and reconstitution of the residue in mobile phase. HPLC separation was carried out at on C(18) column using a mobile phase of 0.05 m dipotassium hydrogen orthophosphate (containing 0.3% v/v triethylamine) adjusted to pH 3.7 with orthophosphoric acid (700 mL), and acetonitrile (300 mL). Flow rate was 0.6 mL/min and the detection wavelength was 280 nm. Retention times were 2.6, 3.7 and 5.8 min for 9-hydroxy risperidone, risperidone and the internal standard, respectively. Linearity in spiked plasma was demonstrated from 2 to 100 ng/mL for both risperidone and 9-hydroxyrisperidone (r > or = 0.999). Total imprecision was less than 13% (determined as co-efficient of variation) and the inaccuracy was less than 12% at spiked concentrations of 5 and 80 ng/mL. The limit of detection, determined as three times the baseline noise, was 1.5 ng/mL. Clinical application of the assay was demonstrated for analysis of post-dose (0.55-4.0 mg/day) samples from 28 paediatric patients (aged 6.9-17.9 years) who were taking risperidone orally for behavioural and emotional disorders.

Physical aggression during admission to a child and adolescent inpatient unit: predictors and impact on clinical outcomes.

OBJECTIVE: Aggressive behaviour is common in young people admitted to child and adolescent inpatient services. Little is known about how physical aggression during admission influences patient outcomes. The aim of the present study was to identify predictors of aggression in a child and adolescent inpatient unit and examine differences in clinical outcomes between aggressive and non-aggressive patients. METHOD: Episodes of aggression occurring within a child and adolescent inpatient unit were prospectively documented between October 2004 and December 2005. Patient factors (demographics, diagnoses, clinical history) were examined as predictors of aggression. Outcomes for admissions in which more than one episode of physical aggression occurred were compared to those in which no aggression occurred. Outcomes assessed were changes in symptom severity (as rated by the Health of the Nation Outcome Scales for Children and Adolescents) length of stay, and initiation of medications. RESULTS: A total of 134 patients were admitted during the study period (61.9% female, mean age=13.8 years, SD=2.9); 31 patients (23.1%) exhibited physical aggression during admission and 20 of these exhibited more than one episode of physical aggression. Factors that predicted persistent physical aggression included history of aggression, use of medications at presentation and absence of self-harm. Persistent aggression was also associated with increased length of stay, but did not compromise improvements in clinical symptom ratings between admission and discharge or lead to increased medication prescribing. CONCLUSION: Contrary to hypotheses and existing research, aggression during admission does not appear to be a barrier to clinical improvement. Further research is necessary to clarify how aggressive children can receive the most benefit from inpatient admission while minimizing the risks to the patient and those around them.