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Since the case of Tarasoff v. Regents of the University of California, mental health professionals have had an explicit legal duty to warn potential adult victims of violence. Subsequent case law expanded this standard to a broader duty-to-protect. Primary health care providers are increasingly treating psychiatric patients for whom the duty to protect is applicable. However, these providers are often unaware of the legal, ethical, and clinical issues involved. Assessment of violence risk should include demographic, psychiatric, and social dimensions. Interventions include notifying law enforcement authorities, potential victims, and possible use of psychiatric hospitalization to prevent aggressive behavior. The duty-to-protect as a standard-of-care has been applied to several other clinical situations, including impaired driving capacity, high-risk HIV behavior, and child sexual abuse. The article includes a step-by-step clinical protocol for evaluation and intervention in dangerous situations.

Summary Children who are recent victims of sexual abuse may initially present to their primary care health provider. Often, the outward manifestations of sexual abuse are somatic complaints or nonspecific behavioral changes. Retrospective reports of adults suggest that about 20-30% of women were sexually abused as children, with figures for men ranging from 10-15%. Interview guidelines for children and adolescents emphasize the need for sensitivity to cognitive development and emotional issues while simultaneously being focused on eliciting specific behavioral data. The use of anatomically detailed dolls, in the context of a comprehensive assessment, is discussed. Health care providers are mandated reporters and must disclose suspected child sexual abuse to the state's child protective service department. Guidelines for reporting as well as addressing this issue with parents are discussed.

Provided preliminary support for the downward extension of the Langner Symptom Survey (LSS) and the Global Severity Index (GSI) of the Brief Symptom Inventory as mass-screening measures of adjustment for adolescents. Adolescents never in treatment obtained significantly lower LSS and GSI scores than adolescents in outpatient or inpatient treatment. Preliminary validity data for use of a cutoff score of 4 on the LSS also was reported. However, additional research is necessary to determine an appropriate cutoff score for adolescents on the GSI.

The present study examined the discriminant validity of the Family-of-Origin Scale (FOS) with 60 self-defined adult children of alcoholics (ACOAs) and 64 undergraduate and graduate university students. The ACOAs obtained significantly lower scores on the 10 FOS subscales, two larger dimensions of Autonomy and Intimacy, and global score. A discriminant function correctly classified nearly 88% of the sample. The findings are generally compatible with theoretical and clinical writing about ACOAs and provide further psychometric support for the FOS as a clinical and research instrument.

Historically, general systems theory has been one of the conceptual foundations for family therapy. However, there are indications that systems theory, originally developed for nonhuman systems, may have significant limitations in accounting for family dysfunction and for guiding intervention. Clinically, systems concepts have been applied in a “one-size-fits-all” manner to families, with little attention to which intervention approaches are optimal for specific families. Ethically, systems therapy presents significant dilemmas in a society that reveres individual rights and well-being. These challenges to the family therapy field are discussed within the context of William Perry's model of intellectual and ethical development.

The effect of consistency in theoretical orientation, whether individual or family, from assessment to therapy on the effectiveness of psychotherapy was examined in archival data. All identified patients (N=131) were ages 5-18 and comprised four groups according to the orientation of their assessment and therapy: the individual-individual (n=49) and family-family (n=49) groups and the individual-family (n=21) and family-individual (n=12) groups. Theoretical consistency was positively associated with therapy duration and participation, as well as with outcome. This association was attributable to the significant relation between family assessment prior to family therapy and the dependent variables of continuation in therapy, percent of sessions attended, nature of termination, and percent of missed sessions. Results support the theoretical position of family therapists that family assessment is the assessment method of choice.

Determined, for each subscale of the Family Environment Scale (FES), whether cutoff scores exist that are related to adolescent distress. TWO epidemiological measures, the Langner Symptom Survey and the General Health Questionnaire, assessed adjustment. We employed a conservative definition of adolescent distress. Analyses revealed that three FES subscales (Cohesion, Conflict, and Active-Recreational Orientation) were related to adolescent distress, regardless of age and sex, and that one FES subscale (Expressiveness) was related to distress in male adolescents but not in female adolescents. We established cutoff scores for each FES subscale found to be related to adolescent distress.