THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective "dialogue" that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

Self-harm among adolescents with developmental disabilities. What are they trying to tell us?

Self-harm behavior exhibited by adolescents with developmental disabilities can be the most challenging behavior for caregivers and health care professionals to address. Past interventions have taken a behavioral approach and focused on functional analysis to guide assessment and treatment. However, self-harm behavior is becoming more recognized as a means of communication. Therefore, it is important for health care professionals and caregivers to listen to adolescents' attempts to communicate and try to understand the meaning of the behavior. Early assessment is crucial to understanding the meaning of the behavior, and early intervention is necessary to prevent escalation or chronicity. Thorough assessment guides interventions and must be implemented in the context of clients' families and social world, and the broader community. Establishment of trusting relationships among adolescents, their families, and health care professionals is imperative. This article discusses self-harm behavior from a psychosocial perspective related to prevalence, onset, purpose, maintenance, and escalation. It also introduces a comprehensive framework to guide assessment and intervention.     

Trends in marijuana and other illicit drug use among college students: results from 4 Harvard School of Public Health College Alcohol Study surveys: 1993-2001

The authors examined changes in college students' illicit drug use, patterns of polydrug use, and the relationship between students' ages of initiation of substance use and later use of marijuana and other illicit drugs between 1993 and 2001. Data from 119 US colleges and universities in the Harvard School of Public Health College Alcohol Study were used in the study. They found significant increases in percentages of students' use of marijuana in the past 30 days (from 13% to 17%), past year (from 23% to 30%), and lifetime (from 41% to 47%) between 1993 and 2001, with most of the increase occurring between 1993 and 1997. Past 30-day use of other illicit drugs increased from 4% to 7% and past year use increased from 11% to 14%. More than 98% of marijuana and other illicit drug users used another substance. They also either smoked, were binge drinkers, and/or were users of another illicit drug. Drug prevention programs should emphasize heavy alcohol use and smoking and should start when students are in high school or earlier.     

Meeting summary--cell biology of Parkinson's disease and related neurodegenerative disorders

Parkinsonian disorders (idiopathic Parkinson's disease and clinically similar disorders) are characterized by impaired movements caused by the degeneration of brain centers involved in regulating normal and smooth movements of the body and its extremities. The mechanisms that cause such degeneration are unknown. This Perspective summarizes research described at a meeting held in June 2003, which was organized by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging to provide an update on recent advances in the cell biology of parkinsonian disorders.     

Influence Diagnostics for Simultaneous Equations Models

This paper presents influence diagnostics for simultaneous equations models. It proposes residuals, leverage and other influence measures. A missing data method is adopted to minimize the masking effect due to case deletions. The assessment of local influence is also considered. The paper shows how to evaluate the effects that perturbations to the endogenous variables, predetermined variables and case weights may have on the parameter estimates. The diagnostics are illustrated with two examples.     

Thinking possibilistically in a probabilistic world

We cannot live on the knife edge of disaster all the time. We cannot even think about disastrous extremes with any clarity, says Lee Clarke . For 300 years we have equated thinking probabilistically with thinking rationally, but is that enough for thinking about terrorism, air crashes—or even God?     

Breast‐Feeding Advocacy,Risk Society and Health Moralism: A Decade’s Scholarship

This article reviews research published this century that engages critically with the mantra ‘Breast is Best’ and the associated expansion of official breast‐feeding promotion programmes. In recent years there has been a marked increase in the number of such studies published. They mostly explore experience in English speaking, industrialised countries (the US, Canada, New Zealand, Australia and Great Britain) which are in some social and cultural respects dissimilar, yet where very similar developments and problems are detected in regards to breast‐feeding promotion. We highlight how this exploration of breast‐feeding promotion internationally has developed understanding of wider sociological themes. This scholarship, we suggest, has provided a powerful illustration of the relation between risk society (more particularly a heightened consciousness of risk) and the evolution of a code of conduct that regulates behaviour, that has been termed ‘health moralizm’. The article covers three themes: ‘Science, risk society, authority and choice’; ‘Public health policy and infant feeding’; and ‘Moralization and women’s identity work’. We conclude that the research discussed shows how the sociological imagination continues to shed light on the relation between private troubles and public issues. We also suggest one conclusion that can be drawn from this research is that official discourse and everyday maternal experience appear increasingly distant from each other.     

Random-effect models with singular precision

We show that smoothing spline, intrinsic autoregression (IAR) and state-space model can be formulated as partially specified random-effect model with singular precision (SP). Various fitting methods have been suggested for the aforementioned models and this paper investigates the relationships among them, once the models have been placed under a single framework. Some methods have been previously shown to give the best linear unbiased predictors (BLUPs) under some random-effect models and here we show that they are in fact uniformly BLUPs (UBLUPs) under a class of models that are generated by the SP of random effects. We offer some new interpretations of the UBLUPs under models of SP and define BLUE and BLUP in these partially specified models without having to specify the covariance. We also show how the full likelihood inferences for random-effect models can be made for these models, so that the maximum likelihood (ML) and restricted maximum likelihood (REML) estimators can be used for the smoothing parameters in splines, etc.     

A divergence test for autoregressive time series models

In this paper, we study the normality test for the innovations of unstable autoregressive models based on the divergence test. In order to investigate the asymptotic behavior of the tests, we use the link between the divergence test and the residual empirical process. Simulation results are provided for illustration.