The utility of extended outpatient civil commitment

OBJECTIVE: This study considers three hypotheses regarding the impact of extended involuntary outpatient commitment orders on services utilization. METHOD: Service utilization of Victorian Psychiatric Case Register (VPCR) patients with extended (> or =180 day) outpatient commitment orders was compared to that of a diagnostically-matched treatment compliant group with similarly extended (> or =180 day) periods of outpatient care (N=1182)--the former receiving care during their extended episode on an involuntary basis while the latter participated in care voluntarily. Pre/post first extended episode mental health service utilization was compared via paired t tests with individuals as their own controls. Logistic and OLS regression as well as repeated measures ANOVA via the GLM SPSS program and post hoc t tests were used to evaluate between group and across time differences. RESULTS: Extended episodes of care for both groups were associated with subsequent reduced use of hospitalization and increases in community treatment days. Extended orders did not promote voluntary participation in the period following their termination. Community treatment days during the extended episode for those on orders were raised to the level experienced by the treatment compliant comparison group during their extended episode and maintained at that level via subsequent renewal of orders throughout the patients' careers. Approximately six community treatment days were required for those on orders to achieve a one-day reduction in hospital utilization following the extended episode. CONCLUSION: Outpatient commitment for those on extended orders in the Victorian context enabled a level of community-based treatment provision unexpected in the absence of this delivery system and provided an alternative to hospitalization.     

Violent media consumption and the recognition of dynamic facial expressions

This study assessed the speed of recognition of facial emotional expressions (happy and angry) as a function of violent media consumption. Color photos of calm facial expressions morphed to either an angry or a happy facial expression. Participants were asked to make a speeded identification of the emotion (happiness or anger) during the morph. Results indicated that, independent of trait aggressiveness, participants high in violent media consumption responded slower to depictions of happiness and faster to depictions of anger than participants low in violent media consumption. Implications of these findings are discussed with respect to current models of aggressive behavior.     

Sexual victimization among African American adolescent females: examination of the reliability and validity of the Sexual Experiences Survey

Adolescent females are disproportionately represented among reported cases of sexual victimization. Because sexual victimization is associated with an array of negative sequelae (e.g., depression, alcohol abuse), psychometrically sound instruments are urgently needed to assess sexual victimization or coercion. The investigation conducts a preliminary analysis of the reliability and validity of the Sexual Experiences Survey (SES) for a sample drawn from a high-risk population-African American adolescent females. Our analyses indicate good internal consistency for the SES with this sample. Convergent validity is demonstrated. Specifically, scores on the SES are associated with significantly lower levels of self-esteem and mastery, higher levels of depression, lower levels of family cohesion, higher levels of family conflict, and higher levels of using alcohol and being a smoker. Preliminary support for discriminant validity is also obtained. This study is a stepping stone for future investigations into the psychometric evaluation of the SES.     

The use of expensive health technologies in the era of managed care: the remarkable case of neonatal intensive care

The use of neonatal intensive care (NIC) continued to rise rapidly in the 1990s despite the concerns of observers about its cost effectiveness and its successes being mostly in facilities with high volume and capabilities. The objective of this study is to test the effects of insurance type, competition among hospitals, and market pressure from managed care plans on the supply and cost of NIC. The analysis uses logistic and linear models with techniques to avoid bias from (a) market area definitions based on actual patient flows and (b) self-selection of hospitals by patients with unmeasured risk of needing NIC. The data source contains all births in short-term hospitals in New Jersey during 1990 and 1994. Both the number of days and charges for NIC are reported. Key findings are that the decision of a hospital to offer NIC was associated with teaching status, the proportion of infants in the market area with documented high risk, and the market concentration of major competitors. The market share of managed care plans and the concentration of enrollment were not associated with either NIC being offered or with the standardized charges. Whether a particular patient was given to a NIC depended on patient risk factors and whether a NIC unit was present, but not on payer group. The results are consistent with the hypothesis that young insured parents (with the advice of their obstetricians) prefer hospitals with NIC and also are relatively profitable enrollees for health plans. In conclusion: using the results here and in other research, public and private policy makers may consider several ways to strengthen the incentives for health plans to contract for cost-effective birth-related services. The results also raise questions for a number of regulatory and payment policies and call for better public data on costs and outcomes for NIC.