Clinical outcomes of a stepped care program for borderline personality disorder.

OBJECTIVE: This study examines the clinical outcomes of two clinics for borderline personality disorder (BPD) in a naturalistic setting, offering a stepped care model with both short-term (ST) treatment lasting 12 weeks and extended care (EC) up to 24 months. METHODS: A total of 479 patients attending the ST clinic and 145 attending the EC clinic were assessed on depression, impulsivity, self-esteem, emotion dysregulation, substance abuse, self-harm and suicidality. RESULTS: There were significant reductions in all symptoms in both clinics with the exception that substance abuse was only reduced in the EC clinic. On all symptoms, no significant differences in magnitude of changes were observed between patients who stayed in EC clinic for 6-12 months in comparison to those who stayed for 18-24 months. CONCLUSIONS: These results support the concept that for the majority of patients with BPD, brief treatment can be effective. While some patients still need longer treatment, the results are encouraging for brief treatment as a first step for the majority of patients with BPD. While this study adds to the weight of evidence to support ST interventions for patients with BPD, further research using a control group is needed. Copyright © 2018 John Wiley & Sons, Ltd.

Accumulation of Risk and Promotive Factors Among Young Children in US Military Families.

In the families of the new cohort of war veterans now entering the civilian population in the United States are over two million young children (Cozza, Haskins & Lerner, 2013; Institute of Medicine, 2013). Several noteworthy studies have shown that children exposed to separation from a parent due to combat-related deployment are at elevated risk for a variety of negative consequences (Lester & Flake, 2013). Cozza et al. (2013) argue that existing studies of military children focus too much on the stresses or deficits they experience, failing to give sufficient attention to their strengths, the strengths of their families, or the supports around them. In the current study we focus on risk and promotive factors in the lives of children aged 0-10 in military families. We examine the likelihood of negative outcomes as functions of additive, cumulative, and interactive relationships between risk and promotive factors and children's outcomes. Risk factors, particularly parental depression, community poverty, and cumulative risk, were more strongly associated with children's outcomes than promotive factors. There was, however, a significant risk-protective relationship between accumulations of risk and promotive factors, consistent with promotive conditions operating in a protective fashion under conditions of elevated risk.

Help seeking by parents in military families on behalf of their young children.

Over the past decade, many children have experienced a parental deployment, increasing their risk for emotional and behavioral problems. Research in the general population has shown that while many services are available for families with children experiencing problems, the rate of service utilization is low. This study examined help-seeking processes in military families in relation to children's problems. We collected data on emotional and behavioral problems from a sample of military parents with children ranging in age from zero to 10 years. While prevalence of children with problems was similar to prior research, results in this study suggested that military parents were alert to problems. Although military parents' help-seeking processes were similar to those documented in civilian studies in many respects, we did not find a significant gender difference in the recognition of problems. Furthermore, we found that children's experiences of deployment were related to use of services. Families who used services most often relied on primary care providers. These findings suggest military families are mindful of the possibility of their children having problems. In addition, many families utilize civilian services. Therefore, it is important to ensure that front-line civilian providers fully understand the context of military family issues.

Effectiveness of a multimedia outreach kit for families of wounded veterans.

BACKGROUND: Young children in military families with a member who has a life changing injury can experience emotional difficulties and behavior changes. OBJECTIVE: This study evaluated a Sesame Workshop multimedia kit called: Talk, Listen, Connect: Changes (TLC-II(C); 2008). The kit, which included video and print materials, aimed to help caregivers (i.e., at-home partner, at-home relative or family member of a current or discharged military member) assist young children as they adjusted to their parent's injury. We expected that the materials would be used and their quality evaluated. We hypothesized that use of the materials would produce improvements in caregiver and child outcomes as well as reductions in perceptions of disruption in the home. We also predicted that kit-use would have a positive impact on the family. METHODS: One-hundred and fifty three families with children aged 2-8 years were randomly assigned to receive the kit being evaluated (TLC-II(C)) or a control kit (Healthy Habits for Life (HHL)), also developed by Sesame Workshop. Group outcomes were compared four weeks following receipt of the kits using multivariate analysis of variance. RESULTS: All materials were well used and highly rated. All caregivers reported less social isolation, less child aggression, and significantly less disruptive home environments after kit use. Test group caregivers reported significantly greater reductions in depressive symptoms and significant increases in children's social competence over time in comparison to the control group. CONCLUSIONS: These results signal important improvements among families as a consequence of using either test or control materials. As a preventative intervention designed for families with an injured member, TLC-II(C) was particularly effective at improving coping.