Behavioral Health Network

The current study was designed to examine if improvements in high school graduation and attendance rates persist 4 years after start times later than 8:30 am. Socioeconomic status and race were accounted for in the graduation analysis. School-wide attendance and graduation records (n = 28 schools) from 1999-2017 were analyzed in August of 2021 using a repeated-measures analysis of variance at 5 points in time, 1 year predelay and 4 consecutive years postdelay start times. Graduation rates for students in grade 12 (n > 47,000) after postdelay year 4 increased from 80% to 90% (P < .001) and attendance rates in grades 9-12 (n > 80,000) improved from 90% to 93% (P = .012). Attendance and graduation rates for all students improved after 4 years following a delayed start. Economically disadvantaged students and Black students showed significant changes in graduation rates postdelay year 4 and White students significantly improved postdelay years 2, 3, and 4. Adolescent students, especially economically and racially disadvantaged students, have a vulnerability for obtaining adequate sleep. Delaying high school start times is a cost-effective intervention that could promote sufficient sleep and boost graduation and attendance rates. McKeever PM, Dodd R, O'Sullivan DM. Delayed high school start times and graduation and attendance rates over 4 years: the impact of race and socioeconomics. J Clin Sleep Med. 2022;18(11):2537-2543.

The aim of the study was to investigate the impact of the absence of a bulbocavernosus reflex in the postoperative period on the neurological and functional recovery 6-12 mos after a motor-complete traumatic spinal cord injury. A retrospective review of a prospective database was completed among 66 patients. The functional and neurological statuses between individuals with and without a bulbocavernosus reflex were compared. A general linear model was used to investigate the association between the postoperative bulbocavernosus reflex status and the functional outcome, using the Spinal Cord Independence Measure. Forty percent of the cohort had no bulbocavernosus reflex 5 days after trauma. Individuals with a bulbocavernosus reflex showed a higher rate of American Spinal Injury Association Impairment Scale grade conversion, improvement of the level of injury, and higher functional scores; however, it did not reach a significant level. The bulbocavernosus reflex status in the postoperative period was not significantly associated with the functional status 6-12 mos after injury. Late recovery of the bulbocavernosus reflex in the postoperative period may be associated with poorer neurological and functional outcome for individuals sustaining a motor-complete traumatic spinal cord injury, for which the prognosis estimation is limited. A prospective study including a larger number of patients is necessary to confirm results of this study.

A local system within what is usually termed the Suncoast Region of southwest Florida, Hillsborough County, which includes the city of Tampa, has long been recognized as one of the more innovative ...

Individuals with direct care responsibilities in 348 drug abuse treatment units were surveyed to obtain a description of the workforce and to assess support for evidence-based therapies. Surveys were distributed to 112 programs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN). Descriptive analyses characterized the workforce. Analyses of covariance tested the effects of job category on opinions about evidence-based practices and controlled for the effects of education, modality (outpatient or residential), race, and gender. Women made up two-thirds of the CTN workforce. One-third of the workforce had a master's or doctoral degree. Responses from 1,757 counselors, 908 support staff, 522 managers-supervisors, and 511 medical staff (71% of eligible participants) suggested that the variables that most were most consistently associated with responses were job category (19 of 22 items) and education (20 of 22 items). Managers-supervisors were the most supportive of evidence-based therapies, and support staff were the least supportive. Generally, individuals with graduate degrees had more positive opinions about evidence-based therapies. Support for using medications and contingency management was modest across job categories. The relatively traditional beliefs of support staff could inhibit the introduction of evidence-based practices. Programs initiating changes in therapeutic approaches may benefit from including all employees in change efforts.

Patient-focused research systems have been developed to monitor and inform therapists of patients' treatment progress in psychotherapy as a method of enhancing outcome. The current study examined the effects of providing treatment progress information to only therapists and to both patients and therapists during the course of psychotherapy. Outpatients (N = 201) at a hospital-based psychotherapy clinic were randomly assigned to 1 of 3 treatment groups: treatment as usual, therapist feedback, and patient–therapist feedback. Patients in the 2 feedback conditions demonstrated significantly greater improvement at termination than those in the treatment-as-usual condition, with no average increase in sessions attended. These findings suggest that providing feedback to patients and therapists may be a viable approach to enhancing patient outcomes.

Boundaries between cultures could be seen as cultural events, fluid and open to change through reconstruction in interaction. These cultural borderlines are a fertile ground for a reflective therapy. In such a therapy we can see, through the eyes of the others, the cultural–ethnic–social dimensions we are made of, not as a mere context for an otherwise universal form of therapy, but as a necessary text to understand who we are. This situated and embodied form of therapy has a critical role to play counteracting the blindly ideological and bureaucratized forms of social engineering that shape most social services nowadays.

In allocating scarce treatment resources to a defined population, college counselors and psychotherapists inevitable function as managers of behavioral healthcare. Empirical research suggests that the brevity of therapy is primarily a function of consumer behavior and that only minimal efficiencies can be obtained through the imposition of arbitrary treatment duration limits. By identifying variables that mediate the relationships among presenting problems, utilization, and outcomes, therapists can actively manage cases and optimize the relationship between treatment efficiency and effectiveness.

The authors describe uses for a 17-item instrument that efficiently measures the functioning level of chronically mentally ill persons living in the community. The Multnomah Community Ability Scale is designed to be completed by case managers who work with chronically mentally ill consumers. The instrument is sensitive to differences among individuals within this special population of consumers and is easy to complete. Community mental health program staff can be trained to use the scale reliably. The scale has been used to compare levels of severity between urban and rural community mental health program clients. The authors discuss the application of the Multnomah Community Ability Scale to a capitated payment system for severely mentally ill, involuntary clients.