Psychosocial profile of HIV-infected adolescents in a Southern US urban cohort.

We undertook a retrospective medical chart review of HIV-infected adolescents referred to a Southern US urban comprehensive adolescent HIV clinic between 1992 and 2003 to describe the psychosocial profile of adolescents infected with HIV via high-risk behaviours.Ninety-one adolescents (59 females, 32 males, 95% African-American, median age 17 years) were identified. Common reasons for initial HIV testing included routine prenatal screening (20%), clinical symptoms suggestive of HIV (20%), and recognized risk-related behaviours (20%). Findings included a history of unstable housing in the previous year (27%), running away (29%), knowing someone with HIV (36%), parental substance abuse (reported by youth, 46%), parental abandonment/neglect (30%), high substance use rates (marijuana 33%, tobacco 27%), current/prior STDs (60%), and involvement with the juvenile justice system or incarceration (41%). Sexual abuse/assault was reported by 41%. Previous depression was reported in 15% with approximately half reporting prior hospitalization. An additional 12% of the cohort had current clinical depressive symptoms. We conclude that infections with HIV via high-risk behaviours during adolescence occur in youth with multiple psychosocial stressors. Targeted prevention efforts to reduce these underlying stressors may decrease new adolescent infection. HIV-infected youth are best served in a comprehensive care environment with immediate access to medical care, social work, and psychology/psychiatry services.

Results of treatment one year later: child and adolescent partial hospitalization.

OBJECTIVE: One criticism of academicians is that they evaluate and disseminate outcome studies based more on the value and merit of the research design than on the utility of the findings for improving clinical practice. Increasing pressure on programs to evaluate the effectiveness of behavioral health care is transitioning outcome measurement from the exclusive domain of the researcher toward the clinical/organizational domain. To explore the multiple applications of such clinical outcome data, this article presents the results from a study of 114 patients completing treatment in two child and adolescent partial hospital programs. METHOD: Four areas define the scope of clinical outcome measurement pertinent to partial hospitalization: changes in the patient's clinical status, changes in the patient's level of daily functioning, impact on the utilization of behavioral health services after discharge, and patient/family satisfaction with treatment. Using these four domains, this study compares data assessed at admission and at 1 year postdischarge. RESULTS: Analyses used paired t tests primarily to measure change between admission and 1 year after discharge. Overall, the data show improvement in general functioning that remains evident up to 1 year postdischarge. CONCLUSIONS: Finding positive results in specific areas emphasized therapeutically--such as family functioning and use of community-based mental health resources after discharge, and the parent's attribution of improvement to experiences in treatment--provides justification for relating improvement to the treatment episode.

Treatment protocols in child and adolescent day treatment.

Twenty treatment protocols in a day treatment program for children and adolescents have been developed by multidisciplinary groups based on a review of 200 patients. The protocols classify patients according to symptom clusters and provide standardized treatment plans for each classification. Each protocol contains a definition of the symptom cluster, a list of presenting problems, a list of other protocols to consider, admission guidelines, treatment options, and discharge criteria. The authors describe the developmental process for the protocols and present a clinical case example to illustrate their use. The application of treatment protocols in research, quality assurance, and teaching is briefly discussed.

Testing the limits: special treatment procedures for child and adolescent partial hospitalization.

How does a child and/or adolescent partial hospitalization program structure care for patients who are suicidal, assaultive, or combative or using drugs? Special treatment procedures designed for use in child and adolescent partial hospitalization programs must adequately address the issue of safety and involve the family and the community, while maintaining the patient in the least-restrictive environment. This paper deals with management of child and adolescent partial hospitalization patients whose behavior and level of impulsivity have escalated to the point where they require special programs. Special treatment procedures for dealing with patients displaying aggressive, acting-out behaviors, noncompliance with program rules, suicidal or runaway ideation, and drug usage are described.

Child and adolescent day treatment: population profile.

This paper presents the demographic and clinical data necessary to define the population of children and adolescents served in a model day treatment program. On the day of admission, patients (N = 204) and parents complete a batter of instruments designed to measure reliably characteristics of the patient's system at three levels: individual, parental, and family. Design of the assessment establishes comparisons among self-report, parent/other report, and clinician report measures at each subsystem level. Results of the CBCL, YSR, PIC, Piers-Harris, MCMI, DAS, and FES indicate moderate levels of disturbance, usually consistent with norms reported on referred or clinical populations. Patients are being treated for a wide variety of childhood disorders within systems demonstrating dysfunction at parental, marital, and familial levels.