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Teacher-student interactions are at the core of formal learning experiences. Since these interactions can be affected by ways in which the teacher or student perceive themselves to be similar, we investigated the effects of racial/ethnic and gender similarities on the type and frequency of disciplinary incidents adolescents were involved in at one middle and one high school. Results indicated that the total number of times a student was disciplined in a given year was higher for students whose race or gender was different from that of their teacher.

Executive functions (EFs) show promise as important mediators of adolescent academic performance. However, the expense of measuring EFs accurately has restricted most field-based research on them to smaller, non-longitudinal studies of homogeneous populations with specific diagnoses. We therefore monitored the development of 259 diverse, at-risk students' EFs as they progressed from 6th through 12th grade. Teachers completed the Behavior Rating Inventory of Executive Function (BRIEF) for a random subset of their students. At that same time, those same students completed the Behavior Rating Inventory of Executive Function-Self Report (BRIEF-SR) about themselves; teachers generally reported stronger EFs in students than students reported in themselves. Results further indicated that both BRIEF and BRIEF-SR Global Executive Composite (GEC) scores--measures of overall executive functioning--significantly predicted overall GPAs more than was already predicted by students' gender, IEP status, and eligibility for free/reduced school lunch. BRIEF (teacher) scores were better predictors and contributed more to predictive accuracy than the BRIEF-SR (student) scores; BRIEF scores even added additional predictiveness to a model already containing BRIEF-SR scores, while the reverse did not hold. This study provides evidence for valid use of BRIEF and BRIEF-SR GEC scores to predict middle and high school GPAs, thereby supporting practitioners use for this purpose within similar, diverse, at-risk populations. The study also illuminates some of the EF development for this population during adolescence.

This random assignment study compared women in a prison Therapeutic Community (TC) program with those in a cognitive-behavioral intervention. Over two thirds of study subjects received a lifetime diagnosis of severe mental disorder, nearly one-half received a diagnosis of PTSD, and virtually all reported exposure to trauma. Preliminary analysis (n = 314) found significantly better six-month post-prison outcomes for the TC group on measures of mental health, criminal behavior and HIV-risk behavior. These findings suggest the short-term effectiveness of prison TC treatment for female offenders with substance use disorders, and underscore the importance of adapting treatment to address mental health. (Contains 4 tables.)

This paper examines outcomes 12 months post-prison release for offenders with co-occurring disorders (n = 185) randomly assigned to either a mental health control treatment (C) or a modified therapeutic community (E). Significant between-group differences were not found for mental health measures, although improvements were observed for each group. Reductions in criminal behavior were associated more with substance use than improvements in mental health symptoms, supporting the primacy of substance abuse treatment in affecting recidivism. Additional study of this population is needed to describe the relationships among diagnostic subgroups, as well as change in substance use and in mental health symptoms. (Contains 4 tables and 2 notes.)

Explores sequential assignment (SA) and treatment-as-usual (TAU) as two approaches to overcome many of the obstacles of random assignment in field studies of treatment efficacy. Substituting SA and TAU for the standard random assignment may introduce methodological impurities including certain limited biases. (SLD)

This article summarizes results from four research studies (n = 902) that examined the effectiveness of the modified therapeutic community (MTC) for clients with co-occurring disorders (most with severe mental disorders). Significantly better outcomes for MTC were found across four experimental versus control comparisons on 23.1% (12 of 52) of primary outcome measures of substance use, mental health, crime, HW risk, employment, and housing. Study limitations included the potential for selection bias, limited measurement of program fidelity, and insufficient examination of the relationship between treatment dose and outcome. Future research should emphasize clinical trial replications, multiple outcome domains, and further development of continuing care models. Given the need for research-based approaches, the MTC warrants consideration when program and policy planners are designing programs for co-occurring disorders. Keywords: Co-occurring disorders; Substance abuse; Severe mental disorder; Modified therapeutic community

This special issue consolidates some recent research findings and scientific thought on co-occurring disorders from both the substance abuse and mental health fields. This summary article recaps and synthesizes the main findings and themes, then considers additional issues in the field today to arrive at an agenda for future co-occurring disorders research. Plans must: (1) encourage and assist further development of treatment programs that respond to an array of types and severities of co-occurring disorders while taking into account the limited resources typically available; (2) continue the development and testing of continuing care models by exploring strategies that will sustain the recovery of treated individuals who remain vulnerable to relapse; and (3) contribute to our understanding of the mechanisms and processes that enable new interventions and practices to be adopted, implemented, and sustained. 'Co-occurring disorders' is a relatively new area of research; this special issue illustrates the productivity of work to date and indicates the potential for advances to come. Keywords: Co-occurring disorders; Research findings; Research synthesis; Severity of mental disorder; Research agenda

This study, which was conducted in an outpatient substance abuse treatment program, randomly assigned clients with mental health symptoms to either a control group, which received basic program services, or an experimental group, which was configured as a modified therapeutic community (TC) track, with the addition of modified TC features and three specific elements--psychoeducational seminar, trauma-informed addictions treatment, and case management. The experimental group had significantly better outcomes as compared with the control group on measures of psychiatric severity and on the key measure of housing stability; no difference was observed for substance use, crime, and employment. The findings must be qualified because (a) only 3 of 34 representative measures ( Keywords: Co-occurring disorders; Substance abuse; Outpatient treatment; Modified therapeutic community; Targeted interventions

Treatment outcomes 1 year after release from prison were compared for two subgroups of male inmates with co-occurring serious mental illness and chemical abuse (MICA) disorders, those with a diagnosis for Antisocial Personality Disorder (APD), and those without a diagnosis of APD. The foundation study had randomly assigned inmates to either Modified Therapeutic Community (MTC) or Mental Health (MH) treatment programs. Results presented in this paper support earlier findings of the overall effectiveness of MTC treatment in correctional settings, and extend these findings to encompass the subgroup of offenders whose cooccurring disorders include APD. An intent-to-treat analysis (all study entrants) and a matched group analysis (Medium propensity stratum) found significantly greater improvement on measures of criminal activity and substance use for those in the MTC group (as compared with the MH group) regardless of APD diagnosis, and showed that negative treatment effects were not linked to APD. Differences between the treatment groups were consistent and significant, and persisted after an examination of various threats to validity (e.g., initial motivation, exposure to treatment, severity of substance use, severity of APD symptomatology). These findings are encouraging and consonant with other studies of the effectiveness of TC approaches for APD populations receiving substance abuse treatment in correctional settings. Given the available evidence and the demand for effective programming for offenders with co-occurring disorders, criminal justice program and policy makers should strongly consider developing modified TC programs across a full array of mental disorders, including APD. doi: 10.1300/J076v44n02_06 KEYWORDS Modified therapeutic community, co-occurring disorders, antisocial personality disorder, treatment outcomes, mental illness and chemical abuse disorder

Passages is a day treatment model based on therapeutic community (TC) methods adapted for methadone maintained clients. The goal of the program is to reduce cocaine use and injection, other drug use, and high-risk sexual behavior. The Passages approach is grounded in a recovery-oriented perspective in which methadone is a prescribed medicine that can facilitate a self help, recovery process. Preliminary evaluation findings on over 500 research participants indicate greater differential improvement in drug-risk behavior and psychological status for the Passages clients who remained 6 months in the program compared to non-Passages clients. Though awaiting controlled studies, the present study demonstrated the feasibility of integrating methadone maintenance and TC-oriented day treatment in methadone clinics; and provided evidence for the effectiveness of the Passages program in reducing risk behavior and improving psychological functioning among seriously dysfunctional substance abusers.

Six years ago, the Colorado Department of Corrections developed a therapeutic community (TC) program for offenders with mental illness and chemical abuse (MICA) disorders. (1) With the assistance of staff [...]

This study compared homeless mentally ill chemical abuser (MICA) clients (n = 342), male and female, sequentially assigned to either of two modified therapeutic community programs ([TC.sub.1] and [TC.sub.2]) and to a treatment-as-usual (TAU) control group. Follow-up interviews were obtained at 12 months postbaseline and at time F (on average more than 2 years postbaseline) on a retrieved sample of 232 (68%) clients and 281 (82%) clients, respectively. Outcome measures assessed five domains: drug use, crime, HIV risk behavior, psychological symptoms, and employment. Individuals in both modified TC groups showed significantly greater behavioral improvement than TAU at 12 months and time F, and the modified [TC.sub.2], with lower demands and more staff guidance, was superior to modified [TC.sub.1]. Completers of both TC programs showed significantly greater improvement than dropouts and a subgroup of TAU clients with high exposure (i.e., more than 8 months) to other treatment protocols. The present findings support the effectiveness and longer term stability of effects of a modified TC program for treating homeless MICA clients., INTRODUCTION Co-occurring Mental Illness and Chemical Abuse The co-occurrence of psychiatric and chemical abuse problems has been reported in the range from 20% to 50% (1-8) among mental health clients [...]

This paper is one of a series reporting on a clinical field trial evaluating the efficacy of the modified therapeutic community (TC) approach for the treatment of homeless mentally ill chemical abusers (MICAs). The social and psychological characteristics of the treatment sample were described in an earlier paper; the purpose of the present report was to categorize subtypes of homeless MICA clients to predict with greater accuracy their treatability in modified TCs. An index that consistently correlated with treatment-relevant variables was identified for each of three dimensions; Homelessness (residential instability), Mental Illness (current severity), and Substance Abuse (current substance abuse/dependence diagnosis). These indices yielded distributions that captured the variability in the sample with respect to a number of variables, including drug use, criminality, human immunodeficiency virus (HIV) risk (sexual behavior), psychological status, and motivation. Bivariate and multivariate analyses showed that the indices were not strongly related to demographic variables such as race/ethnicity, age, or gender, but were significantly associated with baseline drug use, criminal activity, HIV risk (sexual behavior), psychological symptoms, and motivation and readiness. These findings indicate that, even among those admitted to residential treatment for substance abuse, homeless MICA clients are not homogeneous; rather, subgroup differences emerge among the indices of homelessness, mental illness, and substance abuse. The efficacy of treatment in modified TCs for these subgroups will be assessed in subsequent papers examining the relationships among the three indices, client retention, and outcomes during and subsequent to residential treatment., BACKGROUND For over a decade, reports of patients showing evidence of alcohol and/or other substance abuse coupled with mental illness have been increasing in the mental health and drug treatment [...]

The momentum for the integration of substance use disorder (SUD) and health care services is being driven by (a) a growing body of research evidence showing better patient outcomes from integrated services, and (b) policy changes resulting from health care reform. Unfortunately, early signs suggest that the integration of SUD treatment services is not receiving adequate attention in health care settings. After reviewing the impact of health care reform, this paper describes and reviews the research for selected models for integrated care, specific SUD treatment interventions that can be useful in health care settings, and several implementation strategies designed to assist in bringing SUD and health care services together. The article highlights the efforts of the Addiction Technology Transfer Center (ATTC) Network. Comprised of ten Regional Centers, four National Focus Area Centers and a National Coordinating Office, the ATTC Network is the Substance Abuse and Mental Health Services Administration's (SAMHSA) most experienced program to provide workforce development and promote the use of research-based interventions for SUD. Expertise in implementation science/technology transfer strategies combined with a national and regional reach ideally situate the ATTC Network to promote and facilitate the much-needed integration of SUD services and health care. [ABSTRACT FROM AUTHOR]