Improving the quality of drug court clinical screening: a call for performance measurement policy reform

Despite the widespread use of the drug court model, standardized performance measures for drug courts are not uniformly utilized, and rarely include process measures. To ensure that drug courts are being implemented in the most effective manner, the use of performance measurement tools should be considered for wide scale adoption. Drug court effectiveness is moderated by participant characteristics, and is most effective for individuals with the highest substance use needs. Therefore, having quality clinical screening processes is crucial to ensuring that drug courts are serving the population for which they are effective. This paper examines clinical screening in drug courts, to answer the following 1) what is the current state of screening, 2) what works, and 3) why measurement matters. It also proposes a clinical screening performance measure to improve fidelity and ensure appropriate participant enrollment. The creation of a performance measure would create opportunities to improve drug court outcomes, and leverage pay-for-performance models.     

The impact of an intensive inpatient violent offender treatment programme on intermediary treatment targets,violence risk and aggressive behaviour in a sample of mentally disordered offenders*

This study examined the impact of an intensive inpatient violent offender treatment programme, Life Minus Violence-Enhanced (LMV-E), on intermediary treatment targets, risk for violence, and aggressive behaviour during treatment in a sample of male mentally disordered offenders. Using quasi-experimental design, offenders who completed LMV-E and a comparison group showed reduced problems with impulsivity and anger regulation and improvements in social problem solving. Aggregate risk for future violence lessened in both treatment and comparison groups, although by a significantly greater degree for the comparison group. The aggressive behaviour of both groups reduced. Completion of the LMV-E conferred additional improvements in some facets of social problem solving and anger regulation. Neither group showed improvements in empathic responses, coping skills or problematic interpersonal style. Overall, these results suggest anger regulation, impulsivity and social problem solving are most amenable to change, that reductions in certain facets of these dynamic risk factors transpires with nonspecific psychiatric inpatient treatment, but that the LMV-E, a cognitive behavioural violence specific psychological treatment, confers greater change in some facets of social problem solving and anger regulation.     

Psychological models of mental disorder, human rights, and compulsory mental health care in the community

Recent amendments to the 1983 Mental Health Act in the UK (Mental Health Act 2007) include the controversial provision for: “supervised treatment in the community for suitable patients following an initial period of detention and treatment in hospital”. This provision is widespread, and more formal, in other English-speaking jurisdictions. Reviews of the international literature, human rights considerations and the perspective of psychological approaches to mental health care suggest that proposed ‘supervised community treatment orders’ are valuable, lawful, and compatible with the European Convention on Human Rights if certain specific conditions are met. Provisions for ‘supervised community treatment orders’ in the UK should be supported, but with the provisos that: the powers of the Mental Health Act are limited as in Scotland, to persons whose “ability to make decisions about the provision of [care] is significantly impaired”, that each order is time-limited and subject to review by a properly constituted Tribunal, and that the use of such orders should represent a benefit to people in terms of more appropriate treatment, or be a least restrictive alternative, or better preserve the person's private and family life.     

Drugs in injured drivers in Denmark

As part of the project Impaired Motorists, Methods of Roadside Testing and Assessment for Licensing (IMMORTAL) under the European Commission's Transport RTD Programme of the 5th Framework Programme [I.M. Bernhoft, Drugs in accidents involved drivers in Denmark, D-R4.3 of the project Impaired Motorists, Methods Of Roadside Testing and Assessment for Licensing (IMMORTAL), www.immortal.or.at, 2005], a study regarding drugs in accident-involved drivers was carried out in Denmark. The main objectives of this study were: (1) to collect and analyse samples from injured drivers for the presence of drugs; (2) to give an indication whether drugs may have contributed to traffic accidents; and (3) to get information on the drug-positive drivers and their drug use. This paper focuses on objective 1. Injured drivers who were treated in hospital were asked to give a saliva sample, a blood sample or both. The samples were screened for the following substances: opiates, amphetamines, methamphetamines, incl. MDMA (ecstasy), cannabinoids and metabolites, cocaine and metabolites and benzodiazepines. Screenings were carried out by means of Cozart Microplate EIA kit. Positive screenings were confirmation analysed by gas chromatography–mass spectrometry (GC–MS) or liquid chromatography/tandem mass spectrometry (LC/MS/MS). In total, 26 out of 330 patients were confirmed positive for one or more of the six drug groups. However, three patients were excluded from the survey for various reasons. Of the remaining 23 drug-positive patients 15 were found positive for one drug group, and in five of these cases alcohol was present in a concentration over the legal limit in Denmark (0.05%). The other eight patients were found positive for two drug groups, and in four of these cases, alcohol was also present in a concentration over the legal limit. Alcohol was found both in combinations with medicinal drugs, with illegal drugs and with both. Based on the saliva or blood concentrations, we estimate that there is a strong suspicion of impairment in 9 out of 23 cases, and in another six cases it was likely that the drivers were impaired.     

Group Treatment for Spouse Abuse: Are Women with PTSD Appropriate Participants?

Eighty four abused women seeking therapy with their husbands were accepted into a group treatment program for spouse abuse. In the current study, we evaluated the treatment outcome of those women (n = 27) diagnosed with Posttraumatic Stress Disorder (PTSD). PTSD diagnosis, itself, did not differentiate those women who dropped out of treatment. Results indicated, however, that across all women, avoidance symptomatology significantly differentiated treatment completers from dropouts. Although women with PTSD began treatment in worse condition (lower marital satisfaction, higher depressive symptomatology, greater fear of spouse), post-assessment revealed they achieved positive treatment gains parallel to those of women without PTSD. Women with PTSD improved on each outcome variable measured, including a reduction in fear of spouse. Women with PTSD also did not differentially drop out of either treatment condition (men's/women's versus conjoint groups) which lends support to the appropriateness of conjoint treatment for spouse abuse.     

Personality traits of convicted male batterers

The purpose of this investigation is to determine if select psychological variables are associated with abusive behavior of convicted male batterers. The sample included a treatment group of 75 court-referred abusers who were individually administered the Taylor-Johnson Temperament Analysis (T-JTA) instrument. Explored were: (1) the relationships among personality variables and sociological and demographic characteristics, (2) possible behavioral disorders in our study group of spouse abusers, (3) whether major bipolar personality variables could distinguish our study group from the general population. Results revealed the Taylor-Johnson behavioral disorder types were not useful in identifying distinctions among our spouse abusers. However, a two-factor rotation (Internal/Emotional Balance and Social Interaction) produced results which should be of interest to programs treating batterers as well as provide a suggestive lead for future research. Battering men were found to have a restless proclivity for interaction that will be competitive and conflict-oriented in style. Their impulsiveness further suggests that their interactions will be negative in terms of evocation.     

一例药物过敏性休克死亡的医疗问题鉴定分析

目的探讨药物（低分子右旋糖酐）过敏性休克医疗纠纷案件的法医学鉴定思路及关键点，从而为审判提供划分侵权责任及医疗赔偿的科学依据。方法详细报道一例低分子右旋糖酐药物过敏性休克死亡的两级医疗事故鉴定，法医学鉴定及二次不同的法院判决结果的医疗纠纷案例。结果两级医疗事故鉴定均认为该例属医疗意外，不属医疗事故，一审判决驳回起诉。法医学鉴定认为在对该例的抢救过程中确存在不当之处；患者确因药物（低右）过敏性休克死亡，未发现院方有违反医疗常规的行为，对该例的治疗方案属非必要治疗措施。在抢救过程中，肾上腺素没有作为首选用药，肾上腺素应用不及时，药量不充足。因抢救地点的限制致使抢救质量不好。据此，二审判决被告院方对患者方予以赔偿。结论药物过敏性休克的法医学鉴定应注重：①全面审查所提供的详细医疗材料，分析整个医疗过程的临床变化特点；②全面尸检；③进行药品检验、毒物分析；④排除疾病及其它死因；⑤进行确证死因的检验。在此基础上分析确定死因及医疗过程是否存在问题，如存在医疗不当之处，分析此种医疗不当在患者的死亡中的关系比例，并适当表述鉴定意见。     

Alternatives to Custody for High-Risk Young Offenders: The Multisystemic Therapy Approach

This article describes the implementation of randomised trials in Ontario, Canada, of a community-based, therapeutic intervention for youths who would be candidates for custodial sentences because of the severity or persistence of their criminal behaviour. Many recognise the need to reduce custody stays but the realisation of that goal requires the creation of community-based programs which judges believe will not put the public at risk. Reviews of the empirical literature indicated that Multisystemic Therapy could be a cost-effective, individualised, community-based alternative to custody that reduces long and short-term recidivism of high-risk youths.     

Safety, Health Care, and Bonding Within an Ecobehavioral Approach to Treating and Preventing Child Abuse and Neglect

This paper describes Project SafeCare, an ecobehavioral research and treatment project with families reported or at risk for child abuse or neglect. Preliminary demographic data are reviewed along with indirect assessment data. Four case studies are described to exemplify the effects of training provided to families. The implications for the current assessment data, treatment, and outcome are discussed.     

Adolescents with Psychopathic Characteristics in a Substance Abusing Cohort: Treatment Process and Outcomes

Psychopathy is a condition with important consequences both for individuals who experience it and for the communities in which they live. Although the assessment of psychopathy among adolescents remains controversial, some evidence suggests that the affective and behavioral traits of adult psychopathy begin to emerge in childhood (B. B. Lahey & A. Kazdin, 1990) and continue across the lifespan (A. E. Forth, S. D. Hart, & R. D. Hare, 1990). The present study used the Psychopathy Checklist: Youth Version (PCL:YV; A. E. Forth, S. D. Kosson, & R. D. Hare, in press) to retrospectively assess psychopathic characteristics, treatment process, and outcomes of 64 individuals referred for treatment to a substance abuse program for adjudicated adolescents. This study focused on the relationship between psychopathic characteristics and treatment process and outcome variables, including attrition rates, quality of participation, substance use throughout treatment, clinical improvement, and 12-month recidivism rates. Psychopathic characteristics were negatively related to treatment process and outcome variables, including attrition, participation, substance use, and clinical improvement. Psychopathic characteristics were positively related to the number of arrests in the 12 months following treatment completion. Implications for treatment and future research with adolescents displaying psychopathic characteristics are discussed.