Substance use disorders and referral to treatment in substantiated cases of child maltreatment

Parents with substance use disorders (SUD) require treatment and support in order to provide children with appropriate care and protection. Using the 2012 National Child Abuse and Neglect Data System (NCANDS), this paper analysed 464 313 substantiated child maltreatment reports to determine (i) the proportion and characteristics of reports involving substance abuse; and (ii) the child and caregiver/perpetrator (C/P) characteristics that predicted referral to treatment as recorded in service plans. Findings indicate that 12% (N = 53 234) of maltreatment reports involved C/P SUD. Yet, of those reports, only (19%) (N = 10 088) were referred to substance abuse treatment as part of their service plan, indicating a large gap between those who need treatment and those who receive it. This finding is important given that parental SUD is consistently linked to poorer child outcomes. Amongst other variables, reports indicate that C/P with co‐occurring emotional disturbance were three times more likely to be referred to treatment for SUD as part of service plans. Additional research is needed regarding the characteristics that distinguish C/P who receive referrals for SUD treatment in substantiated cases of child maltreatment.     

Characteristics and Outcomes of College-Age Adults Enrolled in Private Residential Treatment: Implications for Practice

Substance use among college-age adults is of interest due to high levels of use and low levels of treatment access and engagement relative to other adults. Data collected from 1,972 clients in residential services were analyzed to investigate differences in use patterns, treatment outcomes, and other life area problems. Participants completed an Addiction Severity Index (ASI) and the University of Rhode Island Change Assessment (URICA) at baseline, and an ASI and Treatment Services Review at 1-month and 6-month postdischarge interviews. Almost a quarter (24.1%) of participants were college age (18–25 years old). They were more likely to be White and male, and less likely to complete treatment although they had a longer average length of stay. College-age adults improved on all outcome measures, and posttreatment service use shows significant difference between college-age and older participants. Implications for practice are discussed.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

Three-group ROC predictive analysis for ordinal outcomes

Measuring the accuracy of diagnostic tests is crucial in many application areas including medicine, machine learning, and credit scoring. The receiver operating characteristic (ROC) surface is a useful tool to assess the ability of a diagnostic test to discriminate among three-ordered classes or groups. In this article, nonparametric predictive inference (NPI) for three-group ROC analysis for ordinal outcomes is presented. NPI is a frequentist statistical method that is explicitly aimed at using few modeling assumptions, enabled through the use of lower and upper probabilities to quantify uncertainty. This article also includes results on the volumes under the ROC surfaces and consideration of the choice of decision thresholds for the diagnosis. Two examples are provided to illustrate our method.     

How can context and discourse affect teachers’ and mental health professionals’ interactions with adults with mental illness?

Patients with severe mental illness may have needs different from those of patients with more limited illnesses and might benefit from other types of intervention than traditional treatment. We interviewed health care professionals from two open, short-term psychiatric wards and teachers from two schools for adults with psychiatric diagnoses. The focus was to explore how differences in contextual factors such as time, tasks, and organizational demands might affect the actions and attitudes of health care professionals and teachers, as well as the potential consequences for patients and students. Data were collected through qualitative interviews. Participants included 14 health care professionals and 14 teachers. The informants worked with patients and students with similar diagnoses and illness durations. All interviews were conducted during the informants’ work time. Findings and interpretations showed that both teachers and health care professionals were engaged in their work and in the wellbeing of students and patients. However, they described marked differences in practice, including the amount of time spent with students/patients, the organization of their work, main tasks, amount of control over their tasks, and social structure. These differences seemed to affect relationships with students/patients, attitudes toward students/patients, norms and values, and opportunities for patient empowerment. Our findings suggest that while existing psychiatric health care might be appropriate for limited short-term problems such as single-episode depression, a model with a supportive environment, based on stable relations and possibility for learning, may improve personal development and mental health for persons with severe mental illness and disturbances in self-experience.     

Using agency data for evidence-based programming: a university-agency collaboration

Agencies providing residential treatment are encouraged, or even mandated, to collect outcomes data and to implement evidence based practices, yet little guidance has been provided on how to do so using agency administrative data that are collected on an ongoing basis. We examined data on Child and Adolescent Functional Assessment Scale (CAFAS) scores for 1608 admissions to a residential treatment center from 2002 through 2008. CAFAS scores were measured every 90 days, providing multiple CAFAS scores for each individual. Results demonstrated that on average residents improved in functioning over time. Sensitive to the evolving needs of residents who had been entering the program, the treatment center made significant program changes in 2006 to attempt to better serve residents through a broad array of specialized programming. Compared to the overall results, the analysis suggested that residents who entered the program since October 2006 appeared to have made larger improvements in their CAFAS scores. Results were derived by employing multilevel models appropriate for estimating growth trajectories with repeated measures data. Conversations with agency staff suggested that using administrative data, and advanced statistical models, were extremely helpful for organizational decision making and evidence-based programming.     

Differential customer racial attitudes toward scandal and patriotism: The Mitchell Report,the Olympics,race, and baseball memorabilia

This paper investigates differential customer racial reaction to negative and positive publicity related to professional athletes. In terms of negative publicity, it analyzes the effect of mention in the Mitchell Report on the price of baseball cards. In regards to positive publicity, it considers the impact of having been identified as a member of the United States Olympic or national team. After controlling for player productivity with performance statistics, the effects of being mentioned in the Mitchell Report are isolated within regression analysis to draw conclusions concerning customer racial attitudes toward the steroids scandal. Similar analysis is conducted to see the impact of being seen as a baseball representative of the United States. Regression results are consistent with the conclusion that negative publicity devalues the cards of nonWhite players but not of White players. Positive publicity, however, increases the value of a player's card regardless of ethnicity.     

Testing for parameter constancy in the time series direction in panel data models

We propose tests for parameter constancy in the time series direction in panel data models. We construct a locally best invariant test based on Tanaka [Time series analysis: nonstationary and noninvertible distribution theory. New York: Wiley; 1996] and an asymptotically point optimal test based on Elliott and Müller [Efficient tests for general persistent time variation in regression coefficients. Rev Econ Stud. 2006;73:907–940]. We derive the limiting distributions of the test statistics as T→∞ while N is fixed, and calculate the critical values by applying numerical integration and response surface regression. Simulation results show that the proposed tests perform well if we apply them appropriately.     

Heterogeneity in treatment effects across diverse populations

Differences in patient characteristics, including age, sex, and race influence the safety and effectiveness of drugs, biologic products, and medical devices. Here we provide a summary of the topics discussed during the opening panel at the 2018 Johns Hopkins Center for Excellence in Regulatory Science and Innovation symposium on Assessing and Communicating Heterogeneity of Treatment Effects for Patient Subpopulations: Challenges and Opportunities. The goal of this session was to provide a brief overview of FDA-regulated therapeutics, including drugs, biologics and medical devices, and some of the major sources of heterogeneity of treatment effects (HTE) related to patient demographics, such as age, sex and race. The panel discussed the US Food and Drug Administration's role in reviewing and regulating drugs, devices, and biologic products and the challenges associated with ensuring that diverse patient populations benefit from these therapeutics. Ultimately, ensuring diverse demographic inclusion in clinical trials, and designing basic and clinical research studies to account for the intended patient population's age, sex, race, and genetic factors among other characteristics, will lead to better, safer therapies for diverse patient populations.     

How much is too much: Does the size of income support transfers affect labor supply?

Cash transfer programs pursue mainly protective objectives, but can also impact rural livelihoods by inducing investments in productive activities and changing household labor allocation. We adopt a continuous treatment approach to quantify how households’ labor supply responds to transfer size. We find a shift from paid labor to own farm labor and find that the transfer size is well within a level that would have disincentive effects on time spent on own farm activities. The switch from paid to own farm labor occurs at lower levels of transfers for labor-constrained households, and at higher levels for non-labor constrained households.