Financial risk, plan types, and authorizations for managed alcohol treatment services.

OBJECTIVE: To estimate the effects of a managed behavioral healthcare organization's (MBHO's) products/plans and financial risk on levels and amount of care authorized for patients with alcohol-related problems. STUDY DESIGN: Secondary analysis of 1995-1998 MBHO authorization files. PATIENTS: Individuals diagnosed as having an alcohol-related problem without comorbidities. METHODS: Episodes (n = 10,872) were constructed with 60-day clear zones. Multinomial regression equations were used to analyze the proportional distribution of care authorized within episodes at 5 levels: inpatient, residential, partial hospitalization, intensive outpatient, and traditional outpatient. Care equivalency hours were calculated to combine data across outpatient sessions and inpatient days. A linear regression equation analyzed quantity of care within episodes. Product/plan types, financial risk, state of residence, and participation in the MBHO's network were explanatory variables. Age, sex, diagnosis, and episode number were control variables. RESULTS: Most utilization management care hours authorized are inpatient and residential. Relative to other products/plans for managing care, utilization management leads to 50% more authorized hours. More financial risk does not predict fewer care units authorized but shifts hospitalizations toward residential treatment. Increasing age and higher-severity diagnoses predict more overnight care authorizations. Pennsylvania, which mandates minimum levels of care and follows American Society of Addiction Medicine criteria, has significantly more care authorized compared with 8 other states with data. CONCLUSIONS: Other than in utilization management, MBHO financial risk does not predict less care authorization. The MBHO authorizes higher-level care for older adults, for those with more severe diagnoses, and for those with episodes of care beyond the second. Authorization data do not necessarily reflect utilization but can provide a useful, partial view of management strategies.

Promoting mealtime communication between adolescent mothers and their infants through videotape.

OBJECTIVE: To use social learning theory to develop and examine the effectiveness of a 15-minute, culturally sensitive videotape in altering mealtime communication and attitudes among African-American adolescent mothers. DESIGN: Randomized clinical trial with baseline and follow-up evaluations. SETTING: High schools, WIC (Women, Infants, and Children) Clinics, and Family Support Centers serving low-income families. PARTICIPANTS: Fifty-nine first-time, African-American adolescent mothers of infants. INTERVENTION: Intervention group viewed and received a copy of a videotape titled "Feeding Your Baby With Love." The messages, title, music, and setting were designed by an advisory group of six African-American adolescent mothers who were filmed feeding their infants in their homes. MEASUREMENTS AND RESULTS: During baseline and follow-up evaluations, mothers were videotaped feeding their baby and completed a questionnaire on attitudes toward mealtime behavior. Analysis of covariance with repeated measures indicated changes in both behavior and attitudes. At follow-up, intervention mothers were more involved with their infant and reported more favorable attitudes toward feeding and communication than control mothers. CONCLUSIONS: Brief culturally sensitive videotapes may be effective strategies to promote parenting skills and to prevent social and health problems among adolescents.

The development of emotion regulation and dysregulation: a clinical perspective.

Clinical conceptualizations of emotion that stress its disruptive influences and functional models of emotion that emphasize its adaptive aspects can be integrated into a developmental psychopathology framework. Under certain conditions, emotion regulation may develop dysregulatory aspects that can become a characteristic of an individual's coping style. This style may then jeopardize or impair functioning and become associated with symptomatic, disordered functioning. Emotional development provides a critical vantage point from which to study the development of symptomatology and psychopathology, particularly given the prevalence of emotional symptoms in various forms of psychopathology. Dimensions of emotionality that can be used to characterize dysregulation include access to the range of emotions, flexible modulation of intensity, duration, and transitions between emotions, acquisition and use of cultural display rules, and the ability to reflect on the complexity and value of one's own emotions in a self-supporting manner. Developmental psychopathology provides a framework within which to examine how emotions are regulatory, how their regulation changes over time, and under what conditions an adaptive emotion process can develop into a pattern of dysregulation that then becomes, or sustains, some symptoms of mental disorders. Such research requires samples that include children with and without risk or presence of particular mental health problems, paradigms that allow the examination of dimensions of emotionality in context and provide multiple assessments that include observations of children's reactions beyond what they themselves can report, and analyses that extend beyond simple global aggregates such as positive and negative emotion. We believe that it is particularly important to study children and their families in situations that challenge their emotional adaptation. The developmental tasks of emotional life evolve in exchanges between the child and the world of events and relationships. The emotional conditions of early childhood appear to be very important in optimizing or interfering with how the child's emotionality regulates his or her interpersonal and intrapsychic functioning and how the child learns to regulate emotion. The experiences that accrue around emotional events influence the stable aspects of the developing personality and become trait-like aspects of the person (Malatesta & Wilson, 1988). Dysregulation occurs when an emotional reaction loses breadth and flexibility. If a dysregulatory pattern becomes stabilized and part of the emotional repertoire, it is likely that this pattern is a symptom and supports other symptoms. When development and adaptation are compromised, the dysregulation has evolved into a form of psychopathology. The line between normative variations and clinical conditions is not clearly drawn.(ABSTRACT TRUNCATED AT 400 WORDS)