Sibling Aggression Among Clinic-Referred Children and Adolescents.

Aggression against siblings has been associated with a number of negative outcomes within community samples of children and adolescents, but little is known about this phenomenon within clinical samples. The current study empirically identified subtypes of sibling aggression, assessed prevalence within a clinic-referred sample of children and adolescents, and described risk factors associated with sibling aggression. Surveys were administered as part of the intake procedures at a community mental health center serving children and adolescents. The current study analyzed reports of sibling-directed aggression and mother-to-child aggression, as well as symptom counts, from a sample of 346 matched pairs of mothers and children or adolescents. Ages of child/adolescent participants ranged from 7 to 18 (M = 12.92, SD = 2.82) and were 55.8% male. The sample was primarily Caucasian (90.2%), were lower income, and resided in a semirural midwestern county. Sibling-directed aggression was reported by 93.1% of mothers and 82.4% of children. Principal components analyses identified two subtypes of sibling aggression, mild and severe. Mother and child/adolescent reports of sibling aggression demonstrated only moderate agreement. Mother-to-child verbal aggression and corporal punishment were more predictive of sibling aggression than more severe maternal aggression, and externalizing symptoms were also associated with sibling aggression. Sibling-directed aggression is very common among clinic-referred children and adolescents and may be an important target for treatment. Using multiple reports of sibling aggression could increase the chances of detection, as would awareness of other risk factors associated with sibling aggression.

Leveraging Electronic Health Record Implementation to Facilitate Clinical and Operational Quality Improvement in an Ambulatory Surgical Clinic.

The implementation of electronic health records is a challenging, complex process requiring significant resources. The temptation is to convert a paper process into electronic format. This strategy fosters a familiar product to the users but is fraught with pitfalls. We chose to utilize the opportunity of the implementation of an enterprise-wide ambulatory electronic health record to foster an overreaching clinical and operational improvement project in a multispecialty surgical ambulatory clinic practice. We interrogated every aspect of the practice: clinic design, scheduling, physical space, staffing, and clinical and operational workflows. We present here the results of a 3-year process improvement.

Patterns of Use, Acute Subjective Experiences, and Motivations for Using Synthetic Cathinones ("Bath Salts") in Recreational Users.

Given the variety and potential toxicity of synthetic cathinones, clinicians and educators would benefit from information about patterns of and motivations for use, frequency of psychosocial consequences, and experience of acute subjective effects. We administered a comprehensive, web-based survey to 104 recreational users of synthetic cathinones. Sixty percent of respondents consumed synthetic cathinones once or more per month, usually snorting or swallowing these drugs, typically at home, usually with others, customarily during the evening and nighttime hours, and often in combination with another drug such as alcohol or marijuana. Acute subjective effects attributed to synthetic cathinones were similar to those of other psychostimulants, including increased energy, rapid heartbeat, racing thoughts, difficulty sleeping, euphoria, decreased appetite, open-mindedness, and increased sex drive. Reported reasons for using synthetic cathinones included its stimulating effects, curiosity, substitution for another drug, and being at a party/music event. Respondents had experienced an average of six negative consequences of using synthetic cathinones during the previous year (e.g., tolerance, neglecting responsibilities, personality change). In combination with previously published investigations, these findings increase our understanding of the reported rationales and outcomes of recreational use of synthetic cathinones.

Grouping Youth With Similar Symptoms: A Person-Centered Approach to Transdiagnostic Subgroups.

OBJECTIVES: The present study extracted symptom profiles based on parent and youth report on a broad symptom checklist. Profiles based on parent-reported symptoms were compared to those based on adolescent self-report to clarify discrepancies. METHOD: The current study used archival data from 1,269 youth and parent dyads whose youth received services at a community mental health center. The mean age of the sample was 14.31 years (standard deviation = 1.98), and the youth sample was half male (50.1%) and primarily Caucasian (86.8%). Latent profile analysis was used to extract models based on parent and self-reported emotional and behavioral problems. RESULTS: Results indicated that a 5-class solution was the best fitting model for youth-reported symptoms and an adequate fit for parent-reported symptoms. For 46.5% of the sample, class membership matched for both parent and youth. CONCLUSION: Latent profile analysis provides an alternative method for exploring transdiagnostic subgroups within clinic-referred samples.

Psychometric evaluation of the Marijuana Reduction Strategies Self-Efficacy Scale with young recreational marijuana users.

INTRODUCTION: This study evaluated the cue-reactivity and several psychometric properties of a questionnaire designed to assess marijuana users' self-efficacy to employ 21 specific cognitive-behavioral strategies to reduce their marijuana use. METHOD: Using a web-based recruitment and data-collection procedure, 513 regular marijuana users completed dependent measures following marijuana-related or control cue exposure. RESULTS: Although exposure to marijuana-related stimuli significantly increased reported craving, mean reduction-strategy self-efficacy scores did not differ as a function of cue exposure. Reliability analyses supported retaining all 21 items as a single scale. Reduction-strategy self-efficacy was positively associated with marijuana-refusal self-efficacy and with recent past use of reduction strategies, was negatively associated with quantity and frequency of marijuana use and marijuana-related problems, and was positively but weakly associated with general self-efficacy. The most frequently reported strategies that were employed reflected restricting marijuana use to once per day, not keeping a large stash available, turning down unwanted hits, and not obtaining more marijuana right away if one's supply runs out. CONCLUSIONS: These findings further support the reliability and validity of the questionnaire when administered to a diverse sample of regular marijuana users.