XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Erik Eriksen is a remarkable individual. He has no college degrees yet is Professor of Human Development at Harvard University. He came to psychology via art, which explains why the reader will find him painting contexts and backgrounds rather than stating dull facts and concepts. He has been a training psychoanalyst for many years as well as a perceptive observer of cultural and social settings and their effect on growing up. This is not just a book on childhood. It is a panorama of our society. Anxiety in young children, apathy in American Indians, confusion in veterans of war, and arrogance in young Nazis are scrutinized under the psychoanalytic magnifying glass. The material is well written and devoid of technical jargon. The theme of the volume is that it is human to have a long childhood which will leave a lifelong residue of emotional immaturity in man. Primitive groups and

Childhood and Society.

Nursing Research—Principles and Methods

https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(16)30142-0.pdf

Mental health of prisoners: prevalence, adverse outcomes, and interventions

Objective To estimate 6-month prevalence of comorbid psychiatric disorders among juvenile detainees by demographic subgroups (sex, race/ethnicity, and age). Design Epidemiologic study of juvenile detainees. Master's level clinical research interviewers administered the Diagnostic Interview Schedule for Children Version 2.3 to randomly selected detainees. Setting A large temporary detention center for juveniles in Cook County, Illinois (which includes Chicago and surrounding suburbs). Participants Randomly selected, stratified sample of 1829 African American, non-Hispanic white, and Hispanic youth (1172 males, 657 females, aged 10-18 years) arrested and newly detained. Main Outcome Measure Diagnostic Interview Schedule for Children. Results Significantly more females (56.5%) than males (45.9%) met criteria for 2 or more of the following disorders: major depressive, dysthymic, manic, psychotic, panic, separation anxiety, overanxious, generalized anxiety, obsessive-compulsive, attention-deficit/hyperactivity, conduct, oppositional defiant, alcohol, marijuana, and other substance; 17.3% of females and 20.4% of males had only one disorder. We also examined types of disorder: affective, anxiety, substance use, and attention-deficit/hyperactivity or behavioral. The odds of having comorbid disorders were higher than expected by chance for most demographic subgroups, except when base rates of disorders were already high or when cell sizes were small. Nearly 14% of females and 11% of males had both a major mental disorder (psychosis, manic episode, or major depressive episode) and a substance use disorder. Compared with participants with no major mental disorder (the residual category), those with a major mental disorder had significantly greater odds(1.8-4.1) of having substance use disorders. Nearly 30% of females and more than 20% of males with substance use disorders had major mental disorders. Rates of some types of comorbidity were higher among non-Hispanic whites and older adolescents. Conclusions Comorbid psychiatric disorders are a major health problem among detained youth. We recommend directions for research and discuss how to improve treatment and reduce health disparities in the juvenile justice and mental health systems.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/208029/YOA20843.pdf

Comorbid Psychiatric Disorders in Youth in Juvenile Detention

PURPOSE: This article reports the findings of a Dialectical Behavioral Therapy-Corrections Modified (DBT-CM) intervention upon difficult-to-manage, impulsive, and/or aggressive incarcerated male adolescents. METHODS: A secondary analysis of a subsample of 38 male adolescents who participated in the study was conducted. A one-group pretest-posttest design was used; descriptive statistics and t-tests were conducted. RESULTS: Significant changes were found in physical aggression, distancing coping methods, and number of disciplinary tickets for behavior. CONCLUSION: The study supports the value of DBT-CM for the management of incarcerated male adolescents with difficult-to-manage aggressive behaviors. Language: en

Impact of a Dialectic Behavior Therapy - Corrections Modified (DBT-CM) Upon Behaviorally Challenged Incarcerated Male Adolescents

Research in correctional settings has progressed from the exploitation of a vulnerable population in the years prior to 1978 to its current overly protective and restrictive state. With the considerable growth in the numbers of inmates with medical and mental health care needs, developing effective interventions to serve this population is paramount. There now appear to be signs of interest in and support for research with inmates by correctional agencies, academia, and health care organizations. Innes (2003) has articulated the following strategies for implementing research in prison: (1) gather stakeholders; (2) include one or more experienced research collaborators; (3) consider obtaining technical assistance from a university or the National Institute of Corrections (NIC); (4) define potential opportunities/interests that support the institution's mission; (5) develop a relationship with an IRB; (6) pilot a small proposal that is of interest and potential value to the organization. The authors illustrate the implementation of a study in a correctional system that uses these strategies.

Conducting research in corrections: challenges and solutions

Problem: To estimate rates of emotional disorder in the Maryland Juvenile Justice system as a guide for planning and policy efforts.

Methods: In this cross-sectional study, psychopathology and level of functioning in a random sample of 312 committed and detained youth (60 females, 252 males) were assessed. Youth diagnostically classified met criteria for mental disorder using the Diagnostic Interview Schedule for Children (DISC) combined with a cut-off score (60 or below) on the Child Global Assessment Scale (CGAS), as established by the National Institute of Mental Health (NIMH).

Findings: Fifty-three percent were classified with diagnosable mental disorders on the DISC, but were above the cut-off scores on the CGAS. Forty-six percent met criteria for diagnosis and low functioning. Twenty-six percent of youth indicated need for immediate mental health services. Fourteen percent with serious mental disorders and substantial functional impairment were in need of a highly restrictive environment as determined by the severity of their offenses.

Conclusions: The number of youth in the Maryland Juvenile Justice System in need of mental health services indicates a need to examine treatment options that meet the requirements for security and treatment. The complexity of problems found in this sample indicates the need for collaborative efforts between mental health and juvenile justice personnel in planning for the immediate and future needs of these youth.

Emotional Disorders in Young Offenders

Involvement in the criminal justice system among adults with serious mental illness doubles the costs of their care. This finding is the result of a careful analysis of two-year costs to three Connecticut systems—mental health, substance abuse, and criminal justice—incurred over two years by more than 25,000 adults with schizophrenia or bipolar disorder. About a quarter of the sample was involved in the justice system, and costs for this group were about double those of the group with no involvement—$48,980 compared with $24,728.

Costs of criminal justice involvement among persons with serious mental illness in connecticut.

This study examined predictor variables that would contribute toward an explanatory model linking child maltreatment and the outcome of crime seriousness. A secondary data analysis was completed on a random sample of youth committed and detained by a juvenile justice system in the northeast United States. Although existing data indicate a predisposition to crime and violence among youth that are maltreated, more research is needed to determine the exact nature of the link, as well as the need to determine the relationship of associated factors. The aim of this analysis was to identify key contextual, child, and parental factors related to maladaptive behavior in abused and neglected adolescent offenders. Logistic regression was used to predict serious criminal outcomes. Overall, 73% of the cases were correctly classified. Ten variables remained in the model to predict serious juvenile criminal behavior. Youth who had been exposed to community violence or who had a mother with mental illness were four times as likely to commit serious criminal behaviors.

Deborah Shelton

Papers

Impact of a Dialectic Behavior Therapy - Corrections Modified (DBT-CM) Upon Behaviorally Challenged Incarcerated Male Adolescents

Conducting research in corrections: challenges and solutions

Emotional Disorders in Young Offenders

Costs of criminal justice involvement among persons with serious mental illness in connecticut.

The role of contextual, child and parent factors in predicting criminal outcomes in adolescence.