An outpatient treatment alternative for suicidal youth.

The present study demonstrates the safety and effectiveness of an outpatient treatment program for suicidal children and adolescents. Pre- and post-treatment measures of patient behavior and family functioning are presented for 47 adolescents and latency-aged children who received treatment from the Systemic Crisis Intervention Program at the Houston Child Guidance Center. Follow-up was conducted at three and six months and at a point between 12-18 months. All measures indicated significant long-term improvement. Data concerning post-institutional use and suicidal behavior are also presented.

Systemic crisis intervention as a response to adolescent crises: an outcome study.

The present study demonstrates the safety and effectiveness of an outpatient program designed to respond to adolescent-precipitated crises by mobilizing and restructuring the family's kinship system. Families of 75 adolescents at risk for hospitalization were followed up to 24 months after treatment with Systemic Crisis Intervention. Measures of offspring and family functioning, suicidal behavior, institutional use, and treatment costs are presented. Results clearly demonstrate the safety, effectiveness, and economic viability of Systemic Crisis Intervention.

Family reconciliation as a response to adolescent crises.

Concern for adolescents who act in dangerous, life-threatening ways has heightened dramatically in recent years. Many of these adolescents appear to come from nuclear families isolated from their kinship systems. Without the mediating effects of kin, the adolescent transition can become a major crisis. Kinship systems remain cohesive when members can reconcile their beliefs about essential aspects of family functioning with the demands for adaptation during major life transitions. Reconciliation is lost when members believe that kin can no longer be trusted to insure their well-being. Kinship fragmentation ensues as family members leave the field or are excluded. Isolated nuclear families then rapidly lose the resilience to respond to life transitions without resorting to extreme, maladaptive solutions. The Systemic Crisis Intervention Program (SCIP) uses the opportunity of the crisis precipitated by the adolescent's life-threatening behavior to alter family myths that have led to network fragmentation. Crisis teams mobilize and meet with kin in four-hour gatherings to foster reconciliation and kinship system reintegration.

Parental facilitation of children's preparatory play behavior in a stressful situation.

Parental behavior has often been cited as a crucial factor in children's ability to cope with stress. However, there has been little study of ways parents help their children adjust to stressful life events. In the present study, 34 parents and children (ages 4-9) were observed preparing for a stressful life event (elective surgery). Parents were asked to prepare their children for the upcoming stress and were given stress-related hospital equipment to use with their child. Specific hypotheses were selected to study the relationships of five parent helping behaviors to children's active preparatory play with stress-relevant materials. Children's preparatory play alone and with an examiner were also observed to test for effects of children on their parents' helping behavior. As expected, parent helping behaviors were significantly related to children's active preparatory play. With the exception of highly directive behavior, however, the relationship of parent helping behavior to child play was dependent on the child's age. This study suggests the importance of further investigating parental involvement in studying the process of children's coping with stress.

Systemic consultation in a general hospital.

Consultation psychiatry has long offered the potential for psychiatrists to impact on the mental health of large numbers of individuals. However, workers in consultation psychiatry have often described it as a stressful, ungratifying experience. Over the last fifty years, since the initiation of consultation psychiatry, a series of models of consult work has been presented in the literature. These models have increasingly become more complex in the system of organization in which they operate. Moreover, there has been a constant movement toward viewing the function of the psychiatrist as intervening in behavior outside of the patient. After reviewing the history of consultation psychiatry, the authors conclude that a logical development would be a systemic model in which the entire hospital system is seen as the focus of consultation and in which the goal of the consultant's work is seen as creating a more open and flexible hospital system. The authors, therefore, describe a systemic model in which the potential crisis offered by any request for consultation work is seen as a tool for intervening with the hospital system. The difficulties of attaining the objectivity necessary for implementing a systemic intervention are discussed. A method of systemic diagnosis of the hospital is presented as well as a number of strategies of intervention with the hospital system. The authors conclude that using a systemic model (with the hospital as the focus of consultation) can lead to the development of a more comprehensive science of consultation which will lead to an increase of gratification for the psychiatrist and a more healthy functioning hospital system.

Experimental production of elevated serum folate in dogs with intestinal blind loops. II. Nature of bacterially produced folate coenzymes in blind loop fluid.

Jejunal and ileal blind loops were constructed in separate groups of dogs and the folate coenzymes present in these loops were investigated. Although only those dogs with high blind loops had appreciably elevated folate levels active for Lactobacillus casei but not Streptococcus faecalis, every blind loop appeared to contain four folate compounds--5-formyltetrahydrofolic acid, 5-methyltetrahydrofolic acid, tetrahydrofolic acid and a compound tentatively identified as 5-formyltetrahydrofolic triglutamate. Why increased levels of 5-methyltetrahydrofolate alone are present in the serum of dogs with a high blind loop is discussed.