Time in Assertive Community Treatment: A Statewide Quality Improvement Initiative to Reduce Length of Participation.

The investigators describe a New York State initiative to increase flow through assertive community treatment (ACT) while encouraging transition to less intensive services. This initiative began as ACT approached full capacity and as evidence emerged that participants can sustain recovery post-ACT. Comparison of performance indicators over time showed that time in ACT decreased, turnover rate increased, and the percentage of ACT participants who met treatment objectives rose. Also, post-ACT rates of ambulatory behavioral health follow-up increased while rates of psychiatric inpatient hospitalization decreased. Monitoring utilization of services while demonstrating positive outcomes has become increasingly critical as states shift to managed health care.

Influence of family and school-level factors on age of sexual initiation.

PURPOSE: This study examined the association of individual, family, and school-level characteristics with age of sexual initiation (ASI) and focused specifically on school context as a moderator of known predictors of ASI. METHODS: Data are from Waves I and IV of the National Longitudinal Study of Adolescent Health (N = 10,596). Predictors include grade point average, physical development, attitudes about sex, likelihood of higher education, alcohol use, delinquency, family structure, parents' education level, childhood abuse, maternal approval of sex, parental monitoring, and parent-child relationship quality. School-level predictors are averages of adolescents' attitudes about sex and likelihood of higher education and parents' education. Hierarchical linear models run separately by sex were used to predict ASI. RESULTS: When school-level attitudes about sex are more favorable, both boys and girls report younger ASI, and school mean parental education attainment moderates the influence of individual adolescents' attitudes about sex on ASI. More of the predictors are significant for girls than boys, whereas perception of maternal and peer approval of sexual activity are the most salient predictors of younger ASI for boys. CONCLUSIONS: Results highlight the importance of school context for understanding adolescents' motivations for early ASI. Findings support the need for school-wide prevention interventions that engage adolescents, peers, and parents in addressing attitudes about early sex.

Personality disorders and mood disorders: perspectives on diagnosis and classification from studies of longitudinal course and familial associations.

The results of three rigorous studies of the naturalistic course of personality disorders indicate the following: (1) personality psychopathology improves over time at unexpectedly significant rates; (2) particular maladaptive personality traits are more stable than personality disorder diagnoses; (3) although personality psychopathology improves, residual effects are usually seen in the form of persistent functional impairment and ongoing Axis I psychopathology; and (4) improvement in personality psychopathology may eventually be associated with reduction in ongoing personal and social burden. A comparison of the longitudinal stability of personality disorders and mood disorders does not support a clear distinction between them based on differential stability of either psychopathology (at least based on remission rates) or functional impairment. Differences may yet emerge with respect to relapse rates over the longer term. Both types of disorders may share some common underlying vulnerabilities best conceptualized in term of personality traits. A group of promising, though methodologically flawed, family studies suggest familiality of at least BPD among the personality disorders and the coaggregation of BPD and depressive disorders (but not bipolar disorders) that may contribute to their frequent co-occurrence. Again, underlying personality traits may prove to be more heritable than either type of disorder.

Family studies of borderline personality disorder: a review.

This paper reviews the literature examining the psychopathology found in relatives of individuals with borderline personality disorder (BPD). Reflecting changes in how BPD has been conceptualized, researchers have investigated the prevalence of schizophrenia, then mood disorders, and more recently, impulse spectrum disorders in these relatives. This literature does not support a link between BPD and schizophrenia, is ambiguous about a link between BPD and major depressive disorder, and suggests a familial aggregation of impulse spectrum disorders and BPD, as well as of BPD itself. Because of significant methodological problems, most notably indirect assessments and inadequate sample size, major questions persist about the familial aggregation of this disorder that require more definitive methods.