Assignment: Psychiatric Hospitals counseling

Assignment: Psychiatric Hospitals counseling ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Psychiatric Hospitals counseling I don’t understand this Psychology question and need help to study. Assignment: Psychiatric Hospitals counseling Hi, I need minimum of 6-8 meaningful sentences 1. Discuss something you found interesting in the required readings. 2. Describe one main challenge of working in a psychiatric hospital. knox__et_al.pdf drymalski__et_al_1_.pdf doerfler__et_al.pdf Psychological Services 2004, Vol. 1, No. 1, 92–99 Copyright 2004 by the Educational Publishing Foundation 1541-1559/04/$12.00 DOI: 10.1037/1541-1559.1.1.92 Treatment and Changes in Aggressive Behavior Following Adolescents’ Inpatient Hospitalization Michele S. Knox, Michael P. Carey, Wun Jung Kim, and Tiffany Marciniak This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Medical College of Ohio The purpose of the study was to describe aggressive behavior in inpatient adolescents and to identify individual characteristics and aspects of mental health treatment that are associated with changes in aggression over time. Type of treatment and treatment satisfaction were examined in relation to changes in aggressive behavior in an inpatient setting and 1 year later. High levels of aggressive behavior were reported at the study onset. Involvement in family therapy/parent training was related to reduced aggression over time. Parental satisfaction was inversely related to improvement. Results indicate the need to involve families in treatment following discharge from inpatient psychiatric hospitalization. sometimes includes the use of medications such as mood stabilizers (e.g., lithium carbonate) or anticonvulsants (e.g., carbamazepine). Although some research exists addressing the effectiveness of these treatments in adults, empirical research on the use of medications for aggression in youth is strictly lacking. Aggressive youth are often involved in the legal system following arrest for a violent crime. Limited research has addressed legal interventions such as incarceration or institutionalization in juvenile detention centers or reform schools. However, one study that reviewed recidivism rates following institutionalization concluded that this intervention does not appear to significantly reduce recidivism (Mulvey, Arthur, & Reppucci, 1993). Some treatments, such as multisystemic therapy (MST; Henggeler & Borduin, 1990) are emerging as promising treatments for youth aggression. MST involves all relevant family members, and treatment occurs in the home or community settings. It is best described as a system of interventions that makes use of family systems techniques and cognitive behavioral techniques. Other issues such as peer relations, parents’ marital problems, family conflict, and school and community problems are also often addressed. Another treatment program, the Oregon Social Learning Center (OSLC) program, has demonstrated efficacy with aggressive, noncompliant children (Forgatch, 1991). This treatment uses bibliotherapy and education and parent training involving the application of social learning principals. A third treatment that has received significant empirical support is parent–child interaction therapy (Eyberg, Boggs, & Algina, 1995). The program targets parent of young children, with the goals of developing (a) a warm and responsive relationship between parent and child and (b) effective parental management of child behavior. Externalizing problems such as aggression are the most-often-cited reason for youth mental health treatment; approximately half of children present for mental health treatment because of aggressive behavior (O’Donnell, 1985). Further, past research indicates significant psychiatric disturbance and high risk for aggressive behavior among formerly hospitalized youth (Knox, King, Hanna, Logan, & Ghaziuddin, 2000). Research indicates that at least half of the youths treated for externalizing problems do not demonstrate long-term improvement (McMahon & Forehand, 1994). Much of the research on treatment outcome has focused not specifically on aggressive behavior but on the broader construct of delinquency (for a review, see Lipsey, 1995). The search for effective treatments specific to adolescents with aggressive behavior problems has identified a number of ineffective treatment modalities. In fact, some treatments, such as group therapy for aggressive youths, have been found to be detrimental (Brewer, Hawkins, Catalano, & Neckerman, 1995). Other treatments, such as individual psychodynamic therapy or insight-oriented therapy have failed to demonstrate effectiveness (Tate, Reppucci, & Mulvey, 1995). Outpatient treatment for aggression Michele S. Knox, Michael P. Carey, Wun Jung Kim, and Tiffany Marciniak, Department of Psychiatry, Medical College of Ohio. This research was supported by the Ohio Department of Mental Health Grant 99-1142. Assignment: Psychiatric Hospitals counseling We express our appreciation to the adolescent inpatient unit nursing and social work staff at the Kobacker Center, Medical College of Ohio. Correspondence concerning this article should be addressed to Michele S. Knox, Medical College of Ohio, Kobacker Center, 3130 Glendale Avenue, Toledo, OH 436145810. E-mail: [email protected] 92 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. TREATMENT AND CHANGES IN AGGRESSIVE BEHAVIOR The identification of effective treatments for youth aggression and related problems has been based largely on studies with children and outpatient or incarcerated/delinquent adolescents. Another highrisk group are those youth who are hospitalized in psychiatric facilities due to their risk for aggression. Inpatient youth are often hospitalized because of serious risk of harm to themselves or other people. Frequently, these youth have demonstrated a serious threat to the safety of self or others by engaging in aggressive acts. Hospitalization is needed to ensure the safety of self or others. Therefore, this is by definition a high-risk group. Nevertheless, effective treatments for aggression in this population have yet to be identified. Some research has begun to identify treatment needs of this group; a recent study (Kashani, Jones, Borduin, Thomas, & Reid, 2000) addressed aggression among inpatient adolescents and related treatment needs. The researchers concluded that, particularly for youth reporting aggression in multiple settings, mental health treatment should focus on faulty thought processing (e.g., cognitive control and expression of anger), peer relations (e.g., association with deviant peers), and family problems (e.g., parent–child conflict). A treatment study addressing anger management group therapy for aggressive inpatients resulted in no changes in aggressive behavior for treatment participants as compared with an attention control group (Saylor, Benson, & Einhaus, 1985). This finding is in keeping with research suggesting that group treatment for aggressive and related behavior problems is at best ineffective and may in fact be harmful (Brewer et al., 1995). Further research is clearly needed in the quest to identify effective treatments for this group of aggressive youth. Follow-up studies examining the effectiveness of various types of treatment for aggression are not available for aggressive inpatient adolescents, and such research will be necessary to guide successful discharge/treatment planning for this group. Another variable that may be related to treatment outcome for aggressive youth is treatment satisfaction. Treatment satisfaction has been proposed as an important variable of interest in mental health systems seeking to maximize outcomes as well as consumer satisfaction. Research with adults indicates strong relationships between client satisfaction ratings and client reports of global outcome (Lebow, 1983), and perhaps for this reason, funding and policy decisions are made on the basis of satisfaction data. However, little is known about the nature of youth treatment satisfaction, and in particular how satisfaction relates to outcome. If important decisions 93 are to be made on the basis of treatment satisfaction data, it is imperative to discover whether, and to what extent, satisfaction is related to outcome or recovery. However, despite the increasing use of satisfaction measures as indicators of positive outcome in mental health treatment for youths, there has been very little research in this area. In particular, child and adolescent satisfaction with treatment has been largely overlooked. Too often, parents or caretakers are asked to report their satisfaction with treatment, with little or no attention paid to the satisfaction of the children and adolescents receiving the services. One study indicated that youth satisfaction with treatment relates to parent- and clinician-reported improvement in behavior, but not youth-rated improvement (Shapiro, Welker, & Jacobson, 1997). In contrast, another study found no relationships between severity of parent-reported emotional and behavioral problems at the end of treatment and youth treatment satisfaction, suggesting no relationship between parent-reported improvement and youth satisfaction (StuntznerGibson, Koren, & DeChillo, 1995). Assignment: Psychiatric Hospitals counseling In another study, adolescents’ ratings of satisfaction correlated significantly and negatively with self-reported severity of mental health problems (Garland, Aarons, Saltzman, & Kruse, 2000). Such conflicting results raise questions about whether there is correspondence between youth satisfaction and youth improvement following mental health services. The objective of the present study was to describe aggressive behavior in inpatient adolescents. The study will also attempt to identify individual characteristics and aspects of mental health treatment (including type and level of satisfaction with treatment) that are associated with changes in aggression over time. Method Participants—Phase 1 Participants were one hundred twenty 13- to 17year-old adolescents who were referred for inpatient psychiatric treatment. Individuals who were unable to complete study measures because of intellectual limitations (e.g., moderate to profound mental retardation) or severe psychosis were excluded from the study. The mean age of the sample was 14.66 years (SD ? 1.38). Of the total sample, 45.8% were male and 54.2% were female. The sample was primarily (87.5%) White/Caucasian, with 5.8% Black/African American, 1.7% Hispanic/Latino/Latina, 0.80% Native American/American Indian, and 4.2% biracial. The sample did not differ significantly from the This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 94 KNOX, CAREY, KIM, AND MARCINIAK larger population of 13- to 17-year-olds admitted to the inpatient unit (i.e., those who did not participate in the study) with respect to age, gender, and race (p > .05). Reason for admission to the hospital was reported by the attending psychiatrist (Wun Jung Kim) upon admission. Of the total sample, 80.7% demonstrated suicidal ideation or self-harmful behavior, 38.0% reported homicidal ideation and/or aggressive behavior, and 54.6% were described as having impaired reality testing, severe mental illness, or other reasons. Many participants had more than one reason for admission. Primary and secondary Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association, 1994) diagnoses were reported by the attending psychiatrist (Wun Jung Kim) upon discharge. The majority, 85%, had some form of mood disorder (e.g., major depressive disorder, dysthymic disorder, bipolar disorder) or adjustment disorder with mood disturbance; 17.5% had an anxiety disorder (e.g., obsessive–compulsive disorder, generalized anxiety disorder); 17.5% had a behavior disorder (attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder); 8.3% had some form of substance abuse or dependence; 4.2% had an eating disorder (e.g., anorexia nervosa, bulimia nervosa); 1.7% had a developmental disorder (autistic disorder, mental retardation); 1.7% had an adjustment disorder without mood symptoms. A full range of socioeconomic status was represented in the sample. Because data were not available for a large proportion (36%) of fathers or male caretakers (in many cases because they were not in the home), this data was dropped from the analysis. The mean socioeconomic index score (Stevens & Featherman, 1981), based on mothers’ occupations, was 31.46 (e.g., sales clerk; SD ? 17.49). Parent occupation scores ranged from textile workers (11.44) to engineers (75.27). Participants—Phase 2 Participants and their caretakers were contacted 1 year following their participation in Phase 1 of the study. In sum, 55 participants and 52 parents/ caretakers completed Phase 2 measures. The Phase 2 adolescent participant sample was 61.8% female and 38.2% male. Similar to the Phase 1 sample, the Phase 2 sample was primarily (85.5%) White/Caucasian, with 5.5% Black/African American, 1.8% Hispanic/ Latino/Latina, and 7.3% biracial. The mean age was 15.93 years (SD ? 1.35). The mean socioeconomic index score, based on mothers’ occupations, was 30.53 (e.g., sales clerk; SD ? 17.52). Parent occu- pation scores ranged from textile workers (11.44) to college professors (79.43). Design and Procedure At their initial appointments or admissions, participants were provided informed consent forms and were asked to provide informed assent for their participation in the study; caregivers were also asked to provide informed consent. This project was approved by the Institutional Review Board of the Medical College of Ohio. Adolescent participants completed the Buss–Durkee Hostility Inventory (BDHI; Boone & Flint, 1988), and the Adolescent Aggressive Incidents Interview—Child Version (AAII–C; Brown, Goodwin, Ballenger, Goyer, & Major, 1979; Knox et al., 2000). They were also administered the Diagnostic Interview for Children and Adolescents (4th ed.; DICA–IV; Reich, Welner, & Herjanic, 1997). The BDHI is a self-report measure of aggressive behavior. Scores on this measure have been found to distinguish between aggressive and nonaggressive groups in home and institutional settings and to correlate with adolescents’ scores on the Conflict Tactics Scale (Boone & Flint, 1988). Higher scores on the measure reflect higher levels of hostility and aggressive behavior. Alpha coefficients have been reported as .88 for aggression toward friends and .92 for aggression toward strangers (Boone & Flint, 1988). Internal consistency alpha coefficients for an adolescent inpatient sample were .91 for aggression toward friends and .94 for aggression toward strangers (Knox et al., 2000). Another recent study (Brent et al., 1993) reported internal consistency of .98 for the Assault subscale with a sample of inpatient adolescents. In the present study, Cronbach’s alpha coefficients were .96 for the total scale, .94 for the Aggression Toward Friends subscale, and .95 for the Aggression Toward Strangers subscale. The AAII is an adaptation of the Brown–Goodwin Assessment for Lifetime History of Aggression (Brown et al., 1979), which was adapted to assess aggressive behavior in adolescents. Adolescents are asked to report how often aggressive behavior and associated consequences occur in the home and outside the home, using a 5-point Likert scale ranging from 0 (never) to 4 (Many times). The adapted scale has nine items. The three-item Home subscale measures aggressive behavior and associated consequences in the home (e.g., “How many times have you lost your temper at home and hurt other people?”). The two-item School/Community subscale addresses aggression at school (e.g., “How many times have you been given detentions at school for This document is copyrighted by the American Psychological Association or one of its allied publishers. Assignment: Psychiatric Hospitals counseling This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. TREATMENT AND CHANGES IN AGGRESSIVE BEHAVIOR fighting or threatening other students, or yelling, threatening, or swearing at teachers?”). The threeitem Community/Work subscale measures aggression in the workplace (e.g., “How many times have you been fired from a job after losing your temper or having verbal or physical fights?”). The four-item Community/Legal subscale measures aggression in the community (e.g., “How many times have you been warned or arrested by police for intentionally destroying someone else’s property, being involved in physical fights, or threatening to or actually using a weapon against someone?”). Higher scores on this measure indicate more aggressive behavior with associated consequences. Internal consistency of the measure has been reported to be high (Cronbachs ? ? .96) in a study using an adolescent inpatient sample (Brent et al., 1993). In a more recent study, Cronbach’s alpha for the adapted adolescent version were .77 for the total scale, .64 for the three-item Home subscale, and .76 for the six-item School/Community subscale (Knox et al., 2000). In the present study, Alpha coefficients were .75 for the total scale, 0.62 for the three-item Home subscale, .73 for the two-item School/ Community subscale, and .77 for the Community/ Legal subscale. The relatively low alpha coefficients may be related to the very low number of items per subscale. Further, the validity of the measure is supported by high correlations with other measures of aggressive behavior in youth (Knox et al., 2000). The DICA–IV is a well-established, validated structured diagnostic interview. Diagnoses are based on DSM–IV criteria. The DICA–IV has been found to demonstrate high correspondence (81.5% agreement) with clinician diagnoses for psychiatric inpatients, aged 7 to 27 years (Welner, Reich, Herjanic, & Jung, 1987). Adolescents’ primary caregivers were interviewed separately and were asked to complete the Adolescent Aggressive Incidents Interview—Parent Version (AAII–P; Brown et al., 1979; Knox et al., 2000), Child Behavior Checklist—Parent Form (Achenbach, 1991), and a brief demographic questionnaire. The AAII–P is an identical scale to the AAII adolescent self-report version (i.e., AAII–C), but evaluates parents’ report of adolescent’s aggressive behavior. In a recent study, alpha coefficients for the adapted parent-report version were .75 for the total scale, .77 for the Home subscale, and 0.67 for the School/Community subscale (Knox et al., 2000). In the present study, alpha coefficients were .78 for the total scale, .66 for the three-item Home subscale, .83 for the two-item School subscale, and .58 for the Community/Legal subscale. 95 The Child Behavior Checklist—Aggressive Scale was used to measure parent-reported aggression in adolescents. The scale is very well established and has been reported to have high test–retest reliability, internal consistency, and discriminant validity (Achenbach, 1991). Each adolescent participant received $10 for completion of the study measures. Caregivers who completed study measures also received $10 for completion of the measures. Participants and their caretakers were recontacted for participation in the second phase of the project 1 year after their participation in Phase 1 of the study. For Phase 2, adolescent participants were asked to complete the BDHI and AAII. They also completed a revised version of the Youth Client Satisfaction Questionnaire, which assessed satisfaction with mental health treatment received in the interim between Phase 1 and Phase 2. The scale demonstrates good (Cronbachs ? ? .90) internal consistency and 3- to 4-week test–retest reliability (r ? .92). Scores have been found to correlate with parent-reported behavior changes, benefits of treatment, GAF scores, and therapist-rated improvement (Shapiro et al., 1997). … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Assignment: Psychiatric Hospitals counseling ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Psychiatric Hospitals counseling I don’t understand this Psychology question and need help to study. Assignment: Psychiatric Hospitals counseling Hi, I need minimum of 6-8 meaningful sentences 1. Discuss something you found interesting in the required readings. 2. Describe one main challenge of working in a psychiatric hospital. knox__et_al.pdf drymalski__et_al_1_.pdf doerfler__et_al.pdf Psychological Services 2004, Vol. 1, No. 1, 92–99 Copyright 2004 by the Educational Publishing Foundation 1541-1559/04/$12.00 DOI: 10.1037/1541-1559.1.1.92 Treatment and Changes in Aggressive Behavior Following Adolescents’ Inpatient Hospitalization Michele S. Knox, Michael P. Carey, Wun Jung Kim, and Tiffany Marciniak This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Medical College of Ohio The purpose of the study was to describe aggressive behavior in inpatient adolescents and to identify individual characteristics and aspects of mental health treatment that are associated with changes in aggression over time. Type of treatment and treatment satisfaction were examined in relation to changes in aggressive behavior in an inpatient setting and 1 year later. High levels of aggressive behavior were reported at the study onset. Involvement in family therapy/parent training was related to reduced aggression over time. Parental satisfaction was inversely related to improvement. Results indicate the need to involve families in treatment following discharge from inpatient psychiatric hospitalization. sometimes includes the use of medications such as mood stabilizers (e.g., lithium carbonate) or anticonvulsants (e.g., carbamazepine). Although some research exists addressing the effectiveness of these treatments in adults, empirical research on the use of medications for aggression in youth is strictly lacking. Aggressive youth are often involved in the legal system following arrest for a violent crime. Limited research has addressed legal interventions such as incarceration or institutionalization in juvenile detention centers or reform schools. However, one study that reviewed recidivism rates following institutionalization concluded that this intervention does not appear to significantly reduce recidivism (Mulvey, Arthur, & Reppucci, 1993). Some treatments, such as multisystemic therapy (MST; Henggeler & Borduin, 1990) are emerging as promising treatments for youth aggression. MST involves all relevant family members, and treatment occurs in the home or community settings. It is best described as a system of interventions that makes use of family systems techniques and cognitive behavioral techniques. Other issues such as peer relations, parents’ marital problems, family conflict, and school and community problems are also often addressed. Another treatment program, the Oregon Social Learning Center (OSLC) program, has demonstrated efficacy with aggressive, noncompliant children (Forgatch, 1991). This treatment uses bibliotherapy and education and parent training involving the application of social learning principals. A third treatment that has received significant empirical support is parent–child interaction therapy (Eyberg, Boggs, & Algina, 1995). The program targets parent of young children, with the goals of developing (a) a warm and responsive relationship between parent and child and (b) effective parental management of child behavior. Externalizing problems such as aggression are the most-often-cited reason for youth mental health treatment; approximately half of children present for mental health treatment because of aggressive behavior (O’Donnell, 1985). Further, past research indicates significant psychiatric disturbance and high risk for aggressive behavior among formerly hospitalized youth (Knox, King, Hanna, Logan, & Ghaziuddin, 2000). Research indicates that at least half of the youths treated for externalizing problems do not demonstrate long-term improvement (McMahon & Forehand, 1994). Much of the research on treatment outcome has focused not specifically on aggressive behavior but on the broader construct of delinquency (for a review, see Lipsey, 1995). The search for effective treatments specific to adolescents with aggressive behavior problems has identified a number of ineffective treatment modalities. In fact, some treatments, such as group therapy for aggressive youths, have been found to be detrimental (Brewer, Hawkins, Catalano, & Neckerman, 1995). Other treatments, such as individual psychodynamic therapy or insight-oriented therapy have failed to demonstrate effectiveness (Tate, Reppucci, & Mulvey, 1995). Outpatient treatment for aggression Michele S. Knox, Michael P. Carey, Wun Jung Kim, and Tiffany Marciniak, Department of Psychiatry, Medical College of Ohio. This research was supported by the Ohio Department of Mental Health Grant 99-1142. Assignment: Psychiatric Hospitals counseling We express our appreciation to the adolescent inpatient unit nursing and social work staff at the Kobacker Center, Medical College of Ohio. Correspondence concerning this article should be addressed to Michele S. Knox, Medical College of Ohio, Kobacker Center, 3130 Glendale Avenue, Toledo, OH 436145810. E-mail: [email protected] 92 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. TREATMENT AND CHANGES IN AGGRESSIVE BEHAVIOR The identification of effective treatments for youth aggression and related problems has been based largely on studies with children and outpatient or incarcerated/delinquent adolescents. Another highrisk group are those youth who are hospitalized in psychiatric facilities due to their risk for aggression. Inpatient youth are often hospitalized because of serious risk of harm to themselves or other people. Frequently, these youth have demonstrated a serious threat to the safety of self or others by engaging in aggressive acts. Hospitalization is needed to ensure the safety of self or others. Therefore, this is by definition a high-risk group. Nevertheless, effective treatments for aggression in this population have yet to be identified. Some research has begun to identify treatment needs of this group; a recent study (Kashani, Jones, Borduin, Thomas, & Reid, 2000) addressed aggression among inpatient adolescents and related treatment needs. The researchers concluded that, particularly for youth reporting aggression in multiple settings, mental health treatment should focus on faulty thought processing (e.g., cognitive control and expression of anger), peer relations (e.g., association with deviant peers), and family problems (e.g., parent–child conflict). A treatment study addressing anger management group therapy for aggressive inpatients resulted in no changes in aggressive behavior for treatment participants as compared with an attention control group (Saylor, Benson, & Einhaus, 1985). This finding is in keeping with research suggesting that group treatment for aggressive and related behavior problems is at best ineffective and may in fact be harmful (Brewer et al., 1995). Further research is clearly needed in the quest to identify effective treatments for this group of aggressive youth. Follow-up studies examining the effectiveness of various types of treatment for aggression are not available for aggressive inpatient adolescents, and such research will be necessary to guide successful discharge/treatment planning for this group. Another variable that may be related to treatment outcome for aggressive youth is treatment satisfaction. Treatment satisfaction has been proposed as an important variable of interest in mental health systems seeking to maximize outcomes as well as consumer satisfaction. Research with adults indicates strong relationships between client satisfaction ratings and client reports of global outcome (Lebow, 1983), and perhaps for this reason, funding and policy decisions are made on the basis of satisfaction data. However, little is known about the nature of youth treatment satisfaction, and in particular how satisfaction relates to outcome. If important decisions 93 are to be made on the basis of treatment satisfaction data, it is imperative to discover whether, and to what extent, satisfaction is related to outcome or recovery. However, despite the increasing use of satisfaction measures as indicators of positive outcome in mental health treatment for youths, there has been very little research in this area. In particular, child and adolescent satisfaction with treatment has been largely overlooked. Too often, parents or caretakers are asked to report their satisfaction with treatment, with little or no attention paid to the satisfaction of the children and adolescents receiving the services. One study indicated that youth satisfaction with treatment relates to parent- and clinician-reported improvement in behavior, but not youth-rated improvement (Shapiro, Welker, & Jacobson, 1997). In contrast, another study found no relationships between severity of parent-reported emotional and behavioral problems at the end of treatment and youth treatment satisfaction, suggesting no relationship between parent-reported improvement and youth satisfaction (StuntznerGibson, Koren, & DeChillo, 1995). Assignment: Psychiatric Hospitals counseling In another study, adolescents’ ratings of satisfaction correlated significantly and negatively with self-reported severity of mental health problems (Garland, Aarons, Saltzman, & Kruse, 2000). Such conflicting results raise questions about whether there is correspondence between youth satisfaction and youth improvement following mental health services. The objective of the present study was to describe aggressive behavior in inpatient adolescents. The study will also attempt to identify individual characteristics and aspects of mental health treatment (including type and level of satisfaction with treatment) that are associated with changes in aggression over time. Method Participants—Phase 1 Participants were one hundred twenty 13- to 17year-old adolescents who were referred for inpatient psychiatric treatment. Individuals who were unable to complete study measures because of intellectual limitations (e.g., moderate to profound mental retardation) or severe psychosis were excluded from the study. The mean age of the sample was 14.66 years (SD ? 1.38). Of the total sample, 45.8% were male and 54.2% were female. The sample was primarily (87.5%) White/Caucasian, with 5.8% Black/African American, 1.7% Hispanic/Latino/Latina, 0.80% Native American/American Indian, and 4.2% biracial. The sample did not differ significantly from the This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. 94 KNOX, CAREY, KIM, AND MARCINIAK larger population of 13- to 17-year-olds admitted to the inpatient unit (i.e., those who did not participate in the study) with respect to age, gender, and race (p > .05). Reason for admission to the hospital was reported by the attending psychiatrist (Wun Jung Kim) upon admission. Of the total sample, 80.7% demonstrated suicidal ideation or self-harmful behavior, 38.0% reported homicidal ideation and/or aggressive behavior, and 54.6% were described as having impaired reality testing, severe mental illness, or other reasons. Many participants had more than one reason for admission. Primary and secondary Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM–IV; American Psychiatric Association, 1994) diagnoses were reported by the attending psychiatrist (Wun Jung Kim) upon discharge. The majority, 85%, had some form of mood disorder (e.g., major depressive disorder, dysthymic disorder, bipolar disorder) or adjustment disorder with mood disturbance; 17.5% had an anxiety disorder (e.g., obsessive–compulsive disorder, generalized anxiety disorder); 17.5% had a behavior disorder (attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder); 8.3% had some form of substance abuse or dependence; 4.2% had an eating disorder (e.g., anorexia nervosa, bulimia nervosa); 1.7% had a developmental disorder (autistic disorder, mental retardation); 1.7% had an adjustment disorder without mood symptoms. A full range of socioeconomic status was represented in the sample. Because data were not available for a large proportion (36%) of fathers or male caretakers (in many cases because they were not in the home), this data was dropped from the analysis. The mean socioeconomic index score (Stevens & Featherman, 1981), based on mothers’ occupations, was 31.46 (e.g., sales clerk; SD ? 17.49). Parent occupation scores ranged from textile workers (11.44) to engineers (75.27). Participants—Phase 2 Participants and their caretakers were contacted 1 year following their participation in Phase 1 of the study. In sum, 55 participants and 52 parents/ caretakers completed Phase 2 measures. The Phase 2 adolescent participant sample was 61.8% female and 38.2% male. Similar to the Phase 1 sample, the Phase 2 sample was primarily (85.5%) White/Caucasian, with 5.5% Black/African American, 1.8% Hispanic/ Latino/Latina, and 7.3% biracial. The mean age was 15.93 years (SD ? 1.35). The mean socioeconomic index score, based on mothers’ occupations, was 30.53 (e.g., sales clerk; SD ? 17.52). Parent occu- pation scores ranged from textile workers (11.44) to college professors (79.43). Design and Procedure At their initial appointments or admissions, participants were provided informed consent forms and were asked to provide informed assent for their participation in the study; caregivers were also asked to provide informed consent. This project was approved by the Institutional Review Board of the Medical College of Ohio. Adolescent participants completed the Buss–Durkee Hostility Inventory (BDHI; Boone & Flint, 1988), and the Adolescent Aggressive Incidents Interview—Child Version (AAII–C; Brown, Goodwin, Ballenger, Goyer, & Major, 1979; Knox et al., 2000). They were also administered the Diagnostic Interview for Children and Adolescents (4th ed.; DICA–IV; Reich, Welner, & Herjanic, 1997). The BDHI is a self-report measure of aggressive behavior. Scores on this measure have been found to distinguish between aggressive and nonaggressive groups in home and institutional settings and to correlate with adolescents’ scores on the Conflict Tactics Scale (Boone & Flint, 1988). Higher scores on the measure reflect higher levels of hostility and aggressive behavior. Alpha coefficients have been reported as .88 for aggression toward friends and .92 for aggression toward strangers (Boone & Flint, 1988). Internal consistency alpha coefficients for an adolescent inpatient sample were .91 for aggression toward friends and .94 for aggression toward strangers (Knox et al., 2000). Another recent study (Brent et al., 1993) reported internal consistency of .98 for the Assault subscale with a sample of inpatient adolescents. In the present study, Cronbach’s alpha coefficients were .96 for the total scale, .94 for the Aggression Toward Friends subscale, and .95 for the Aggression Toward Strangers subscale. The AAII is an adaptation of the Brown–Goodwin Assessment for Lifetime History of Aggression (Brown et al., 1979), which was adapted to assess aggressive behavior in adolescents. Adolescents are asked to report how often aggressive behavior and associated consequences occur in the home and outside the home, using a 5-point Likert scale ranging from 0 (never) to 4 (Many times). The adapted scale has nine items. The three-item Home subscale measures aggressive behavior and associated consequences in the home (e.g., “How many times have you lost your temper at home and hurt other people?”). The two-item School/Community subscale addresses aggression at school (e.g., “How many times have you been given detentions at school for This document is copyrighted by the American Psychological Association or one of its allied publishers. Assignment: Psychiatric Hospitals counseling This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. TREATMENT AND CHANGES IN AGGRESSIVE BEHAVIOR fighting or threatening other students, or yelling, threatening, or swearing at teachers?”). The threeitem Community/Work subscale measures aggression in the workplace (e.g., “How many times have you been fired from a job after losing your temper or having verbal or physical fights?”). The four-item Community/Legal subscale measures aggression in the community (e.g., “How many times have you been warned or arrested by police for intentionally destroying someone else’s property, being involved in physical fights, or threatening to or actually using a weapon against someone?”). Higher scores on this measure indicate more aggressive behavior with associated consequences. Internal consistency of the measure has been reported to be high (Cronbachs ? ? .96) in a study using an adolescent inpatient sample (Brent et al., 1993). In a more recent study, Cronbach’s alpha for the adapted adolescent version were .77 for the total scale, .64 for the three-item Home subscale, and .76 for the six-item School/Community subscale (Knox et al., 2000). In the present study, Alpha coefficients were .75 for the total scale, 0.62 for the three-item Home subscale, .73 for the two-item School/ Community subscale, and .77 for the Community/ Legal subscale. The relatively low alpha coefficients may be related to the very low number of items per subscale. Further, the validity of the measure is supported by high correlations with other measures of aggressive behavior in youth (Knox et al., 2000). The DICA–IV is a well-established, validated structured diagnostic interview. Diagnoses are based on DSM–IV criteria. The DICA–IV has been found to demonstrate high correspondence (81.5% agreement) with clinician diagnoses for psychiatric inpatients, aged 7 to 27 years (Welner, Reich, Herjanic, & Jung, 1987). Adolescents’ primary caregivers were interviewed separately and were asked to complete the Adolescent Aggressive Incidents Interview—Parent Version (AAII–P; Brown et al., 1979; Knox et al., 2000), Child Behavior Checklist—Parent Form (Achenbach, 1991), and a brief demographic questionnaire. The AAII–P is an identical scale to the AAII adolescent self-report version (i.e., AAII–C), but evaluates parents’ report of adolescent’s aggressive behavior. In a recent study, alpha coefficients for the adapted parent-report version were .75 for the total scale, .77 for the Home subscale, and 0.67 for the School/Community subscale (Knox et al., 2000). In the present study, alpha coefficients were .78 for the total scale, .66 for the three-item Home subscale, .83 for the two-item School subscale, and .58 for the Community/Legal subscale. 95 The Child Behavior Checklist—Aggressive Scale was used to measure parent-reported aggression in adolescents. The scale is very well established and has been reported to have high test–retest reliability, internal consistency, and discriminant validity (Achenbach, 1991). Each adolescent participant received $10 for completion of the study measures. Caregivers who completed study measures also received $10 for completion of the measures. Participants and their caretakers were recontacted for participation in the second phase of the project 1 year after their participation in Phase 1 of the study. For Phase 2, adolescent participants were asked to complete the BDHI and AAII. They also completed a revised version of the Youth Client Satisfaction Questionnaire, which assessed satisfaction with mental health treatment received in the interim between Phase 1 and Phase 2. The scale demonstrates good (Cronbachs ? ? .90) internal consistency and 3- to 4-week test–retest reliability (r ? .92). Scores have been found to correlate with parent-reported behavior changes, benefits of treatment, GAF scores, and therapist-rated improvement (Shapiro et al., 1997). … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10