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Wednesday, October 31, 2007

PREDICTORS OF SUBSTANCE USE AND FAMILY THERAPY OUTCOME AMONG PHYSICALLY AND SEXUALLY ABUSED RUNAWAY ADOLESCENTS

There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment as usual. Abused adolescents reported lower family cohesion at baseline, although both abused and nonabused adolescents showed similar substance use reductions. Utilizing hierarchical linear modeling, we found that substance use changed with change in cohesion over time. These findings link change in family functioning to change in adolescent substance use, supporting family systems theory. Findings suggest that a potent target of intervention involves focus on increasing positive communication interactions.

The National Child Abuse and Neglect Data System (NCANDS) reported that in 2002 an estimated 1,800,000 referrals were made alleging child abuse or neglect to state and local child protective services agencies. Of these referrals, 896,000 children were determined to be victims of child abuse by the Child Protective Services (CPS) agencies. Even with this high number of youth and families affected by abuse, the consensus within the literature is that there are few rigorously designed treatment evaluation studies for maltreated youth (Cohen & Mannarino, 1998; James & Mennen, 2001; Stevenson, 1999). Several researchers have noted that treatment efforts are still in the early stage of development, and more attention is needed for identifying effective interventions (Finkelhor & Berliner, 1995; Kolko, 1996; Swenson & Spratt, 1999). To that end, this study examined substance abuse treatment outcome and its predictors among physically and/or sexually abused adolescents.

It has been suggested that there is no special sexually abused children's syndrome or symptom characteristic of a majority of such children (Finkelhor & Berliner, 1995; Kendall-Tackett, Williams, & Finkelhor, 1993). Physical and/or sexual abuse affects diverse sets of youth with a wide range of ages, backgrounds, and associated symptom presentations. Problem behavior patterns vary by age as well, with running away or substance use typical of older children and nightmares and anxiety more typical of younger children (Finkelhor & Berliner, 1995).

Stevenson (1999) and Beutler and Hill (1992) suggest that the lack of a specific childhood abuse syndrome and the diversity of those affected calls into question whether specific therapies are required for abuse or whether treatment should focus on the presenting symptoms rather than on child abuse specifically. These authors question whether therapy should focus on the youth's history of physical and/or sexual abuse or on issues, such as depression or substance abuse, that prompt treatment seeking. Finkelhor and Berliner (1995) conclude that, because of the diversity among abused children and families, it is unlikely that any one therapy will be effective for all children and families. These researchers note that treatment evaluation with a homogeneous group with similar symptoms allows an intervention to be systematically administered and evaluated. This study included a relatively homogeneous group of physically and/or sexually abused adolescents as they had run away from home and were substance abusing.

Child Sexual and Physical Abuse

Finkelhor and Berliner (1995) reviewed 29 studies examining treatment outcome with sexually abused children and adolescents. Of these, five published studies used an experimental design in which children were randomly assigned to a treatment condition; only two of the studies (Baker, 1987; Monck et al., 1994) included adolescent participants. In both studies, client outcomes improved with treatment, though outcomes were similar across conditions.

More recently, Cohen and colleagues (Cohen, Deblinger, Mannarino, & Steer, 2004; Cohen & Mannarino, 1998, 2000) compared the efficacy of trauma-focused, cognitive-behavioral therapy (TF-CBT) and child-centered therapy for treating posttraumatic stress disorder and other emotional/behavioral problems in children aged 8 to 14 years who had a history of sexual abuse. These researchers found that those children and parents assigned to the TF-CBT, as compared to those assigned to the child-centered therapy, demonstrated greater improvement along many dimensions, such as depression, behavior problems, abuse-related distress/attributions and parenting practices.

Compared with studies on child sexual abuse, even fewer studies have examined treatment with physically abused children (James & Mennen, 2001). Milner and Chilamkurti (1991) noted that parental aggression, parental distress, and family conflict are risk factors for childhood physical abuse. Given the role of parents in the abuse of their children, most treatment-outcome research has focused on treatment of the parent, excluding the family or child. However, comprehensive treatment targeting multiple systems has the advantage over individual treatment models through addressing the many needs of children and their families (Swenson & Spratt, 1999).

Enterprise architecture is not rocket science

Some areas of networking, such as satellite communications, actually involve rocket science. Building an enterprise architecture, however, is not rocket science. Its goal is to create a unified IT environment of standardized hardware and software systems across the firm, with tight links to the business side of the organization.

Many companies have made major IT investments in recent years and need to optimize these assets. Organizations with informationintensive operations, such as banks, brokerage firms and insurance companies, typically spend as much as 6% to 10% of gross revenue on their IT budgets. IT assets encompass logical resources,such as applications and databases, as well as physical resources, such as processors, storage and networks. A firm optimizes these assets by developing an enterprise architecture - a blueprint of its information systems and technology environment.

With an enterprise architecture, a company creates a map of its IT assets and business processes, and a set of governing principles that support the business strategy and how it can be expressed through IT. The enterprise architecture specifies equipment, protocol and interface standards; IT strategies; projects needed to bring about the architecture and achieve the target state; and a development/deployment plan.
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There are many models for developing an enterprise architecture, including the Open Group Architecture Framework, the Zachman Architecture Framework and the Federal Enterprise Architecture Framework. Most frameworks contain four basic domains: 1) business architecture - documentation that outlines the firm's most important business processes; 2) information architecture - documentation that identifies where important blocks of information, such as customer records, are kept and how to access them; 3) application system architecture - a map of the software applications' relationships to one another; and 4) infrastructure technology architecture - a blueprint of the firm's hardware, storage systems and networks.

The importance of having an enterprise architecture for large operations is reinforced by the Clinger-Cohen Act of 1996, which authorized for all federal agencies a CIO responsible for developing, maintaining and facilitating a sound and integrated IT architecture.

But remember, enterprise architecture is not rocket science. It involves following proven do's and don'ts, including:

* Have an underlying architecture framework and a road map for realizing your target.

* Have standards and conformance criteria.

* Use industry-developed approaches and modeling tools, not homegrown architecture frameworks and models.

* Hire and utilize the right people.

* Don't spend years developing the framework and lose credibility with the firm about the value of enterprise architecture.

* Don't be in a situation where there are no mechanisms for enforcing the architecture effectively.

* Don't rubber-stamp every project; make sure they conform to the enterprise architecture.

* Don't make architecture artifacts so esoteric that no one uses them after they are written.