Commentary on the Revision of SAMHSA's National Outcome Measures (NOMs) for Discretionary Programs.

Data collection is an integral part of government agencies like the Substance Abuse and Mental Health Administration (SAMHSA), for reporting program outcomes and accountability. SAMHSA-funded community behavioral health programs have been evaluated by the National Outcome Measures (NOMs) since 2007. NOMs collects data on important aspects of client health including but not limited to mental health symptoms, functioning, and social connectedness through interviews with clients. Since its inception, NOMs has gone through a number of revisions. The most recent revision in 2021 has significant implications for program evaluation and research. This commentary provides an overview of the history of the NOMs followed by a review and critique of the recent changes with a particular attention to revisions in how responses are recorded. Implications of the NOMs are discussed with respect to its utility in evaluation, practice, and research.

Opportunities to improve behavioral health crisis response: Results of a large urban county's community status assessment.

A comprehensive community status assessment of an Ohio urban county's crisis response (CR) system explored the experiences of its behavioral health services' clients and providers to surface themes characterizing the system's responsiveness and identifying opportunities for improvements. Forty-eight focus groups and two online surveys were conducted. Data were analyzed using qualitative content analysis and descriptive statistics. The greatest areas of needed improvement ascertained by this effort are in increased CR system resources, more efficient use of resources, and capacity enhancements in nine areas: the mobile crisis team, CR protocols, psychiatric inpatient and crisis stabilization beds, stabilization admission for eligible persons, stabilization services for in-crisis but admission-ineligible persons, continuity of care, research into child versus adult CR systems, Provider Emergency Support Program, and first responder crisis intervention training. The assessment provides a foundation for the county to identify further opportunities for system scale-up.

Concordance of Parent- and Child-Reported Physical Abuse Following Child Protective Services Investigation.

Knowledge about the concordance of parent- and child-reported child physical abuse is scarce, leaving researchers and practitioners with little guidance on the implications of selecting either informant. Drawing from a 2008-2009 sample of 11- to 17-year-olds ( N = 636) from Wave 1 of the second National Survey of Child and Adolescent Well-Being, this study first examined parent-child concordance in physical abuse reporting (Parent-Child Conflict Tactic Scale). Second, it applied multivariate regression analysis to relate parent-child agreement in physical abuse to parent-reported (Child Behavior Checklist) and child-reported (Youth Self Report) child behavioral problems. Results indicate low parent-child concordance of physical abuse (κ = .145). Coreporting of physical abuse was related to clinical-level parent-reported externalizing problems ([Formula: see text] = 64.57), whereas child-only reports of physical abuse were the only agreement category related to child-reported internalizing problems ( B = 4.17, p < .001). Attribution bias theory may further understanding of reporting concordance and its implications.

The Beech Brook Group Therapy Assessment tool: a pilot study.

BACKGROUND: Assessment is a critical component of therapeutic intervention as it serves as the basis from which clinical goals and objectives are derived. Unfortunately, there is a dearth of reliable group therapy assessment instruments, especially for children and preadolescents who have severe emotional disturbances. OBJECTIVE: The purpose of this study was to test reliability of a newly developed group therapy assessment instrument for use with children who have serious emotional disturbances that require placement in a residential or partial hospitalization treatment program. METHODS: After conducting an extensive literature review, the authors developed, refined, and tested a group therapy assessment tool for use in both music therapy and traditional therapy, measuring nine items: attention to task (physical and verbal), eye contact, pro-social skills (physical and verbal), empathy (physical and verbal), and managing negative affect (physical and verbal). Six participants with a mean age of 9.5 (SD = 1.85) years were randomly selected to test the group therapy assessment tool from a pool of 60 eligible children receiving group partial hospitalization therapy. Participants were scored by three raters across two partial hospitalization therapy groups for inter-rater reliability. Content and construct validity were also examined. RESULTS: Intraclass Coefficients (ICC) averaged 0.994 across all nine items indicating excellent inter-rater reliability. Content and construct validity was established and the instrument demonstrated good external validity potential. CONCLUSIONS: The Beech Brook Therapy Assessment Instrument has demonstrated excellent inter-rater reliability in measuring important behaviors of functioning central in the treatment of youth with severe and emotional disturbances. The measure has potential for wide utility and application in practice and research; however, future studies are needed to establish external validity.

Endodontic 'Solutions'. Part 2: An audit comparing current practice in Belfast with UK and Republic of Ireland Dental Schools.

UNLABELLED: Endodontic lubricants, irrigating solutions and medicaments help reduce the microbial load within root canals. Primary and secondary cases involve different microbes. Each'solution'or combinations thereof could play a significant role but no detailed guidelines exist on their use. An audit was undertaken to compare current practice in Belfast Dental School to the others across the UK and Republic of Ireland (ROI). This audit highlighted three main differences between Belfast and other dental schools. Many other institutions utilized other irrigants besides sodium hypochlorite (NaOCl), different intracanal medicaments, including calcium hydroxide, and higher concentrations of NaOCl. Having gathered this information, we ask, 'Is there sufficient evidence to change the endodontic regime currently used at Belfast Dental School?'. Using the findings from the literature review (Part 1), we introduce new evidence-based protocols for primary and secondary cases for use in Belfast Dental School. CLINICAL RELEVANCE: In the absence of detailed clinical guidelines on the use of endodontic lubricants, irrigants and medicaments in primary and secondary cases, it is important to be aware of current practice in UK and ROI dental schools where dentists and specialists are trained.

Endodontic 'solutions' part 1: a literature review on the use of endodontic lubricants, irrigants and medicaments.

Endodontic lubricants, irrigants and medicaments help prepare and disinfect root canal systems (RCS) but primary and secondary cases involve different microbes and therefore it is unlikely that one protocol will be effective for both case types. Each individual 'solution' or sequence of'solutions' could play a significant role in each case type, but there are no detailed published guidelines in existence. To help inform clinical practice it was decided to undertake a literature review followed by a UK and Republic of Ireland wide audit on current endodontic'solution' usage within dental schools. The literature review was undertaken under the following headings: pre-op oral rinse; file lubricants; root canal irrigants and intracanal medicaments and provides an evidence base for protocol development for both primary and retreatment cases.The audit project and the protocols developed from the findings of both the literature review and audit will be presented in Part 2.

Fracture resistance of aluminium oxide and lithium disilicate-based crowns using different luting cements: an in vitro study.

AIM: The aim of this study was to investigate the fracture resistance of two types of ceramic crowns cemented with two different cements. METHODS AND MATERIALS: Forty premolar crowns were fabricated using lithium-disilicate (IPS Empress-2) and glass-infiltrated aluminium-oxide (In-Ceram) ceramic systems. The crowns were divided into four groups (n=10) with Group 1 (IPS Empress-2) and Group 2 (In-Ceram) cemented with glass ionomer cement. Group 3 (IPS Empress-2) and Group 4 (In-Ceram) were cemented with resin cement. Crowns were tested in a universal testing machine at a compressive-load speed of 10 mm/min. Fracture modes were grouped into five categories. One way analysis of variance (ANOVA) and Bonferroni post-hoc tests were used to detect statistical significances (p<0.05). RESULTS: The mean (SD) fracture resistance (Newtons) for Groups 1 to 4 were: 245.35 (82.69), 390.48 (67.03), 269.69 (10.33), and 418.36 (26.24). The cement type had no statistical significant effect (p>0.05) on fracture resistance within each ceramic system tested. In-Ceram crowns cemented with either glass ionomer or resin cements exhibited a statistically significantly higher fracture-resistance than IPS Empress-2 crowns (p<0.05). Minimal fracture in the test crowns was the common mode exhibited. CONCLUSION: Fracture resistance of IPS Empress-2 and In-Ceram crowns was not affected by the type of cement used for luting. CLINICAL SIGNIFICANCE: Both In-Ceram and IPS Empress-2 crowns can be successfully luted with the cements tested with In-Ceram exhibiting higher fracture resistance than IPS Empress-2.

Understanding clinical complexity in delinquent youth: comorbidities, service utilization, cost, and outcomes.

This study describes the extent and severity of multiple comorbidities in ajuvenile detention center population, and explores how these numerous problems impact the utilization of treatment services, costs, and outcomes including those for substance abuse, mental illness, and criminal activity. Cluster analyses of the outcome scales at intake yielded two groups: youth high (42%) and youth lower (58%) on all factors. Girls experienced the most significant impairments across emotional problems, behavior complexity, internal mental distress, and victimization domains, utilized significantly more units of residential treatment,individual counseling and case management, and had the highest treatment costs. The total cost of services ($1,171,290, N = 114) was significantly related to substance problems in the past year (r = .219, p < .05), emotional problems (r = .237, p < .05), behavior complexity (r = .318, p < .05), internal mental distress (r = .263, p < .05), environmental risk (r = .205, p < .05), and conflict tactics (r = .240, p < .05). Despite initial differences in measures of baseline severity, high and low cluster youth, and boys and girls in general, achieved similar results on the key outcome variables 12 months later. Study implications include a need for co-occurring, integrated treatment efforts that address family, emotional, and mental health problems of delinquent youth (especially females) in order to improve their ability to successfully attend to substance abuse problems and interpersonal conflicts.

Characteristics and trajectories of treatment foster care youth.

Using cross-sectional analyses in conjunction with dynamic modeling (hierarchical linear modeling), the authors profiled 119 treatment foster care youth and constructed behavioral change trajectories for a subset of 97 children. Children generally showed improvements in internalizing and critical pathology problem domains but remained the same on measures of externalizing behaviors and total problem score. The number of previous out-of-home placements was positively associated with increased levels of psychiatric symptomatology and served as the most robust predictor for modeling treatment response trajectories across problem domains. Placement instability places the well-being of children at heightened risk, therefore, accurate assessment of child need and risk in relation to caregiver capacities is critical.

Forecasting length of stay in child residential treatment.

A sample of 126 consecutively admitted residential treatment children (mean age = 9.86, SD=1.84; 70.6% male; 42.1% African American; 50% Caucasian) were studied over a five-year period to identify predictors of length-of-stay. Cox regression was the primary statistical method used to analyze psychiatric and behavioral rating data for children assessed by teachers and treatment staff using the Devereux Scales of Mental Disorders (DSMD). Parental alcohol abuse, and children's age, medication status, race, initial DSMD total and critical pathology scores, were predictive of length-of-stay. Residential length-of-stay was strongly linked to initial levels of psychiatric symptomatology. Models that can help forecast length of stay are vital tools in helping to improve both clinical and utilization management strategies.

Music therapy assessment for severely emotionally disturbed children: a pilot study.

The purpose of this study was to pilot a music therapy assessment instrument for severely emotionally disturbed children. The subjects in this pilot were 20 children, 13 male and 7 female, at a residential treatment center in Cleveland, Ohio. After conducting an extensive literature review, the authors developed a music therapy assessment instrument measuring 4 relevant domains: behavioral/social functioning, emotional responsiveness, language/communication abilities, and music skills. Responses were coded into 3 categories: defensive/withdrawn, target behavior, and disruptive/intrusive. Results demonstrated that subjects displayed significantly more behaviors in the disruptive/intrusive domain. High inter-rater reliability scores of 91.5% for percent agreement and .808 for Cohen's kappa were achieved utilizing this assessment instrument.

Behavioral change trajectories of partial hospitalization children.

Forecasting treatment outcomes is essential to improving service delivery. Hierarchical linear modeling was used to construct behavioral change trajectories and help predict treatment responsiveness for 97 partial hospitalization children. Overall, children evidenced statistically significant improvement in psychiatric symptomatology. Younger age, female gender, number of previous out-of-home placements, and lower IQ scores were associated with increased psychopathology and poorer treatment response. Properly configured day treatment can provide an effective organizing platform for implementing complex treatment regimes.