Browsing by Subject "Treatment Outcome"
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Item Comparing Distribution-Based and Anchor-Based Minimal Clinically Important Difference Values for Temporomandibular Disorder(2011-10-03T15:30:19Z) Ingram, Megan Elizabeth; Gatchel, Robert J.The current study is a continuation of studies by Gatchel and colleagues. Data were collected from 101 patients at several community dental clinics. Based on the patients' initial evaluations, they were randomly assigned to one of three treatment groups: Low Risk/Non-intervention Group; High Risk/Biobehavioral Group; or High Risk/Self-Care Group. This study attempted to better understand and objectively quantify meaningful symptom relief by determining the minimal clinically important difference (MCID) for temporomandibular joint disorder (TMD). Despite limitations and controversy with determining the most appropriate method, this information will play an important role in determining treatment effectiveness for not only TMD, but for other pain conditions as well. The most commonly referenced methods for determining meaningful change are the distribution- and anchor-based approaches. Distribution-based minimal detectable change (MDC) values were calculated using the formula 95% CI=1.96 x Square Root(2) x SEM, while the anchor-based approach minimal clinically important change (MCID) values were calculated using a Receiver Operating Curve (ROC). Both mean particle size and broadness of distribution served as two separate functional anchors, and normal range and .5 SD as two separate cutoff methods. Despite some variability, the MCID values were relatively consistent with the MDC values regardless of method, anchor, or cutoff for both the Physical Component Scale (PCS) and Mental Component Scale (MCS) of the SF-36. The Characteristic Pain Inventory and Graded Chronic Pain Scale showed a narrow range of variation within the MCID values; however, the MCID values calculated were significantly higher than the MDC values reported for the same measures. Findings indicated that the PCS component of the SF-36 provided stronger evidence of clinically meaningful change. The PCS resulted in asymptotic values closer to .1 (at the 90% confidence interval) with areas under the curve that better fit the model compared to the other subjective measures (considered fair at .701 when using the normal range and .740 when using .5SD for the Biobehavioral Group). Additionally, broadness of distribution resulted in more clinically meaningful changes as a result of better metric values when comparing the biobehavioral versus the self-care groups. [Keywords: minimal clinically important difference; temporomandibular disorder; minimal detectable change, TMD; outcome measure]Item Computer-Administered Patient Reported Outcomes (PRO) and Psychiatric Screening in Outpatient Pain Patients: Effect of a Point-of-Care Biopsychosocial Patient Health Report on Treatment Outcomes(2012-08-13) Swanholm, Eric Neal; Gatchel, Robert J.Rationale: Chronic pain is a widespread health problem that carries steep costs for both individuals and society. Pain-related complaints represent one of the most common presenting symptoms across ambulatory care settings. Individuals with chronic pain often have comorbid psychiatric symptoms and/or psychosocial dysfunction. Given the related impact on treatment and health-care costs, tracking psychiatric and psychosocial outcomes is beneficial for chronic pain patients, their health care providers, and service providers. Outcome-tracking interventions that could positively affect treatment outcomes hold potential benefits for patient care. Purpose: The purpose of the present study was to examine the effects of the regular collection and results feedback prior to the point-of-care on multiple patient-reported outcome (PRO) domains in outpatient pain patients. Maximizing ecological validity and non-disruption of clinic flow were given significant focus in the study design and process. Patients and Methods: This study used repeated measures and was conducted in an outpatient pain management and interdisciplinary treatment clinic (2 anesthesiologists, 1 psychiatrist, 1 psychologist, 1 counselor, 1 physical therapist). A total of 69 pain patients were randomly assigned to one of two protocol-based PRO feedback intervention groups (separate feedback to both patients and providers [Dual Feedback]; Provider-Only Feedback) or a non-intervention group (Chart-Review Only). Assessments were completed prior to the point-of-care; feedback for intervention groups was based upon a real-time, automated report generated from their PRO data. Data were gathered on touch-screen tablet-pc’s using multiple computer-adaptive-tests from the NIH-sponsored Patient Reported Outcomes Measurement Information Systems (PROMIS) Assessment Center platform; outcome domains included pain-related functioning (Pain Disability Questionnaire [PDQ]; VAS pain rating; PROMIS Physical Functioning, Pain Behavior, and Pain Interference), psychological symptoms and psychosocial variables (PROMIS Depression, Anxiety, Sleep-Related Impairment, Fatigue, Social Functioning; hypomania history screen; Pain Medication Questionnaire [PMQ; opioid misuse risk]), global HRQoL (PROMIS Mental and Physical Health domains), treatment alliance (Working Alliance Inventory [WAI]; ratings from both patients and providers]), and illness perception and optimism (Brief Illness Perception Questionnaire [BIPQ]; Life Orientation Test- Revised). Performance-based data (walking time, grip strength, range-of-motion/flexibility) were collected by the physical therapist for study patients whose treatment included a PT component (e.g. interdisciplinary pain program, individual services). Significant covariates were identified and incorporated into the primary analyses. Primary outcomes were the individual measures within each outcome domain. Analyses utilized mixed-effects modeling with random coefficients and multiple regression in comparisons of all three study groups. Secondary analysis included tabulation of completion time and comparisons between a Combined Feedback group (both intervention groups) and Chart-Review Only. Results: Significant covariates included treatment type, history of psychiatric diagnosis, and a biological family history of psychiatric diagnosis. Comparing Dual Feedback vs. Chart Review Only, patients in the Dual Feedback intervention had significantly better outcomes over time for a number of domain outcomes; specifically, in pain-related functioning/symptoms (PDQ [P = .003]; PROMIS Pain Interference [P = .023]; VAS pain [P = .03]), psychological and psychosocial variables (PROMIS Anger [P = .001]; PROMIS Anxiety [P = .012]; PROMIS Depression [P = .029]; PROMIS Sleep-Related Impairment [P = .001]; PROMIS Social Functioning – Satisfaction with Discretionary Social Activities [P = .047]), PROMIS Global HrQOL (Mental Health [P = .021]; Physical Health [P = .032]), treatment alliance (WAI – Bond [patient-rated][P = .046]), illness perceptions (BIPQ – Consequence [P = .017]; BIPQ – Timeline [P = .011]; BIPQ – Treatment Control [P = .029]), and one performance-based measure (Walk Time [P = .007]). Similarly, patients in the Provider-Only group had better outcomes over time for multiple outcome domains; including, pain-related functioning/symptoms (PDQ [P = .033]; PROMIS Pain Interference [P = .031]; PROMIS Fatigue [P = .036]; PROMIS Physical Functioning [P = .049]), psychological and psychosocial variables (PMQ [opioid misuse risk][P = .041]), treatment alliance (WAI – Bond [patient-rated][P = .076]; WAI – Bond [provider-rated][P = .008]), illness perceptions (BIPQ – Timeline [P = .048]; BIPQ – Personal Control [P = .027]), and one performance-based measure (Walk Time [P = .035]). Comparisons between patients in the Dual Feedback and Provider-Only Feedback groups were significant for a few domain outcomes. Compared to Provider-Only Feedback, Dual Feedback had better outcomes over time for multiple domain measures; including, the PDQ (P = .085), PROMIS Anger (P = .000), PROMIS Anxiety (P = .018), and BIPQ – Treatment Control (P = .015). Conversely, the Provider-Only group had better outcome scores over time for PROMIS Global HrQOL (Mental Health (P = .032); Physical Health (P = .074). Analyses of process variables showed a mean completion time of 15.8 minutes for the entire assessment; completion-time statistics were also calculated for the 11 PROMIS computer-adaptive-tests (M = 7.57 minutes [all PROMIS CAT’s]; M = 41.3 second per measure, SD = 9.3 seconds) and other primary outcomes (PDQ, PMQ, BIPQ) (M = 8.23 minutes total; M = 2.74 minutes per measure, SD = .99 minutes). Conclusion: The provision of dual feedback (patient and providers) from PRO data collected prior to the point-of-care had an impact on several outcomes from multiple domains (pain-related functioning, psychological symptoms, psychosocial variables, illness perception, walking performance) over time, compared to patients who received no point-of-care feedback. To a lesser extent, group by time effects were also observed in comparisons between patients receiving provider-only feedback and those with no feedback. Brought together, high ecological validity was maintained with minimal disruption of clinic flow; likely contributing factors include the use of a set framework for outcome-tracking, protocol-based delivery of feedback, and efficiency of administration. This is the first study to show the potential benefits of providing PRO data feedback to both patients and providers prior to the point-of-care. [Keywords: chronic pain, patient-reported outcomes, biopsychosocial, patient feedback, computer-adaptive-testing, point-of-care, treatment outcomes, PROMIS]Item Does Depressive Severity Have an Immediate Effect on Therapeutic Distance at Mid-Acute Phase in Cognitive Therapy for Recurrent Major Depressive Disorder?(2011-02-01T19:33:39Z) Bowers, Alycia D.; Minhajuddin, AbuThe degree to which severity of depression predicted Therapeutic Distance (TD) was researched with 375 patients with recurrent Major Depressive Disorder who received Cognitive Therapy. Therapeutic Distance was calculated by subtracting Working Alliance Inventory-Form C (WAI-C) from Working Alliance Inventory-Form T (WAI-T). Therapeutic Distance of each of the three subscales of the WAI was also calculated in order to determine whether the severity of depression predicted TD in the Bond, Task, or Goal subscales. The extent to which the severity of depression had an effect on the TD from midpoint to endpoint of the study was determined. Furthermore, the severity of depression and response to treatment at the first blind evaluation was analyzed. Results suggested that depressive severity was not predictive of TD overall or of the three subscales. However, when looking at TD over time, it seems that TD task is significantly different from midpoint to endpoint of the acute phase CT. Additionally, it appears that regardless of the severity of depression, the working alliance was established rather quickly and remained fairly stable throughout the acute phase of the study.Item Dynamic Magnetic Resonance Imaging for Tumor Prognosis(2006-08-11) Jiang, Lan; Mason, Ralph P.Breast and prostate cancers are the most common non-smoking cancers among American women and men. Radiotherapy and chemotherapy in conjunction with surgery are the most common treatment protocols in the clinic. However, a lot of experimental and clinical studies have shown that tumor hypoxia and the microcirculation play a very important role in cancer progression and therapy. There is strong evidence that hypoxic cells are one of the major reasons for failure to control tumors with conventional radiotherapy and chemotherapy. Several approaches (hyperthermia and carbogen inhalation), which improve tumor oxygenation during radiotherapy and chemotherapy, have been used in clinical trials. There is increasing demand for tumor prognostic information in the clinical setting. So far, increasing clinical data have indicated that poorly oxygenated tumors have poor prognosis. To better understand the underlying tumor physiological mechanisms, it is very important to develop novel non-invasive approaches to accurately assess tumor microcirculation and oxygenation for further therapy planning. However, these parameters have been extremely difficult to assess in routine clinical practice and have therefore not been easily integrated in to general patient care. With development of MRI the non-invasive technique, BOLD (Blood Oxygenation Level Dependent) contrast MRI, has been widely used for neuroscience research to detect brain activations. Because deoxyhemoglobin (dHbO2) is paramagnetic and oxyhemoglobin (HbO2) is non-magnetic, the change of concentration of deoxyhemoglobin and oxyhemoglobin can cause a Bulk Magnetic Susceptibility (BMS) change and the T2* signal response during MR imaging. Here, I applied this technique to assess tumor physiological characteristics. In order to study the BOLD mechanism, I designed a phantom system and built it for in-vitro study. Since inhalation of oxygen could cause variation in the blood flow and oxygenation, and BOLD MRI is sensitive to both these factors, it becomes very important to explore the correlation between the BOLD response and these two factors. Considering the different vascular orientation, the angle between vessel and the static magnetic field (BItem Expectancy, Adherence, and Depression as Predictors of Therapeutic Outcome as Measured by PTSD Symptoms in Veterans with MST(2012-05-18) Azimipour, Solaleh; Suris, AlinaBACKGROUND: The aim of this study was to explore the association between treatment outcome expectancy, adherence to treatment, and depressive symptoms on symptom reduction in the treatment of PTSD in Veterans. SUBJECTS: Participants were female and male veterans from a large Southwestern Veterans Administration Healthcare System. A total of 129 participants were randomized to receive cognitive processing therapy (CPT) or present-centered therapy (PCT). Participants completed baseline assessments prior to starting 12 sessions of therapy. METHODS: Data from the Clinician Administered PTSD Scale (CAPS), the PTSD Checklist (PCL), Beck Depression Inventory II (BDI-II), the 16-Item Quick Inventory of Depression Symptomatology (QIDS), Expectancy of Therapeutic Outcome (ETO), homework assigned to the participants, and the number of therapy sessions completed were used in the analysis of the hypotheses. Spearman correlations and multiple regressions were used to analyze the data RESULTS: Both number of sessions attended in the CPT group and number of sessions attended in both groups combined were significantly associated with an improvement in depression symptoms as measured by change in the QIDS score (CPT ? = .31, both ? = .29). Attendance to sessions in the CPT group was not associated with change in the PCL score. The total average minutes spent on homework in the CPT group was significantly associated with worsening of PTSD symptoms as measured by an increase in the CAPS score (? = -.51) in one model and by an increase in the PCL score (? = -.30) in a separate model. The percent of homework assignments completed in the CPT group was significantly associated with improvement in PTSD symptoms as measured by a decrease in the CAPS score (? = .32). A significant relationship was found between outcome expectancy and the number of sessions attended in the PCT group (? = .42;.39). The relationship between baseline depression symptom level as measured by the QIDS and the total average number of minutes spent on homework fell short of significance in the CPT group, p = .07. There were no significant associations between baseline depression and treatment outcome expectancy. DISCUSSION: Greater outcome expectancy was associated with increased attendance to sessions in the PCT group, but not in the CPT group. However, greater expectancy did not predict adherence to homework and the amount of time spend doing homework. As expected, in the CPT group as well as both groups together, greater attendance to sessions was associated with an improvement in symptoms of depression. Greater adherence to homework assignments was associated with an improvement in PTSD symptoms. Contrary to predictions however, greater time spent doing the homework was associated with a worsening of PTSD symptoms and greater depression at baseline was associated with greater time spent completing homework. Furthermore, baseline depression did not predict treatment outcome expectancy, and expectancy did not predict PTSD and depression symptoms at treatment completion. IMPLICATIONS: A greater expectation of benefit from treatment could be an indication that an individual is motivated to change. It is possible that expectations of treatment, attendance to therapy sessions, and completing homework in between sessions, are the key to benefiting from therapy.Item Outcomes of Supported Employment for Individuals with Severe Mental Illness(2011-12-14) Pursley, Matthew Ray; Casenave, Gerald W.Individuals with severe mental illnesses such as severe Major Depressive Disorder, Bipolar I Disorder, Schizophrenia, and Schizoaffective Disorder face heavy barriers to employment, including the symptoms of the disorders themselves, medication side effects, and stigma and misconceptions about mental illness from coworkers and employers. Consistent employment has a strong positive impact on recovery prognosis for the severely mentally ill, but up to 90% are unemployed in spite of their own desire for competitive employment and the presence of federal legislation and incentive programs intended to reduce unemployment in this population. Literature shows that access to and participation in supported employment services is the most powerful predictor of competitive employment for those with severe mental illness, but the presence of differing models of rehabilitation contributes to inconsistent levels of service and results. The medical model and the recovery model are two of the most popular and widespread models of rehabilitation currently in use. Research comparing these models is necessary to determine which is more effective at helping the mentally ill achieve and maintain competitive employment. This thesis reviews relevant literature and presents a research design for a nonequivalent group study inspired by the Metroplex Employment Model, comparing the outcomes of the medical model of rehabilitation and placement with those of supported employment within the recovery model of rehabilitation. The goal is to determine which service format provides the desired results (prompt and sustained employment) more efficiently and consistently, making process-based and outcomes-based program evaluation a vital part of the design. Samples of program evaluation forms can be found in the Appendix. It is hypothesized that supported employment services following a biopsychosocial, recovery-based model will result in consumers with severe mental illness attaining employment significantly more quickly and sustaining it for longer than rehabilitation services that follow the traditional medical model. Following the literature review and basic design, there is discussion of the importance and implications of the results of such a study, potential improvements upon the design, and variations on how the data may be computed.Item Predictors of Success Across Differing Interdiscilinary Pain Programs: Who Benefits from Which Treatment?(2009-09-04) Oslund, Sarah Renee; Robinson, Richard C.This study aimed to examine predictors of completion and success in interdisciplinary treatment for chronic pain and to provide clinicians with relevant information in determining the appropriate treatment intensity for patients. A total of 1,062 patients were examined who participated in one of three different levels of treatment intensity: a 120 hour treatment program (n=699), a 72 hour treatment program (n=61), and a 24 hour treatment program (n=302). Results indicated that higher levels of anxiety and greater number of visits to the emergency room in the twelve months prior to treatment were predictive of premature termination of treatment in the more intensive program. For less intensive programs, number of hours resting per day was predictive of early termination of treatment. Predictors of success were then examined utilizing five definitions of success. No single measure was found to be a significant predictor across all five domains. However, lower levels of health care utilization, higher levels of affective distress, greater perceived interference from pain, and lower levels of perceived control were predictive of successful outcomes. Overall, the findings indicate that individuals with greater dysfunction at treatment entry will benefit more from treatment. When comparing three programs of different intensities, the most intensive program produced a higher proportion of successful outcomes. Pre-treatment variables were explored as a means of identifying relevant clinical variables that could be utilized by clinicians to identify the most appropriate treatment program for patients. Greater number of hours resting and higher levels of pain at pre-treatment were found to be useful variables. Namely, those resting more than seven hours per day or reporting pain levels higher than six out of twelve indicated a need for the most intensive program.Item A Proposed Battery Used to Monitor Treatment Outcomes In Individuals with Multiple Sclerosis: A Case Study(2013-05-17) Riggs, Amanda Lynn; Gatchel, RobertBACKGROUND: Multiple Sclerosis (MS) is a chronic disease of the central nervous system. As of now, there is no cure for MS, but different forms of treatment have been studied to ameliorate both physical and psychosocial symptoms. Numerous measures have been used within the MS population to monitor symptoms before, during, and after treatment. The aim of this present study was to ensure the usefulness of a battery of outcome measures that will assess MS-related symptoms before and after standard treatment. Another aim of the study was to assess treatment outcomes and determine the current success of each individualized treatment plan. SUBJECTS: All participants had a confirmed diagnosis of MS, were able to read and write in English, were 18 years of age and older, and able to walk, even briefly, with or without an assistive device. Participants were recruited through The University of Texas Southwestern Medical Center, Multiple Sclerosis Clinic. METHOD: Ten qualified MS patients were given a Six-minute walk test, two cognitive tests, and nine psychosocial measures as a baseline assessment. After six to eight weeks of Standard care, all participants were asked to return in order to complete all the measures again. It was hypothesized that the proposed battery of measures would prove to be useful in monitoring treatment outcomes in patients with MS. It was also hypothesized that individualized treatment would prove to be beneficial to each participant over the course of the study. RESULTS: This study did not provide any evidence that the individualized treatment was beneficial. Moreover, it did not provide any evidence that this particular battery was sensitive enough to truly monitor treatment outcomes. There was only one significant difference found between initial and follow-up assessment. The sum of ranks for the BORG was 0.00 (Z = -2.00, p = .046, r = -0.89) when comparing breathlessness scores. This indicates that individuals that returned for follow-up assessment experienced less breathlessness at follow-up assessment before and after the Six-minute Walk Test than before and after the Six-minute Walk test upon initial assessment. DISCUSSION: The period between assessments may not have been long enough to identify any changes in treatment or treatment outcomes. Due to the unpredictable nature of MS, it may be important for providers to assess individuals using a comprehensive, biopsychosocial battery on a case-by-case basis rather than a generalized pre-established time frame.Item Referral Source as a Predictor of Treatment outcomes in Children and Adolescents with Major Depressive Disorder(2009-09-04) White, Heather Hayes; Kennard, Beth D.Information was obtained from two previously conducted studies of children and adolescents with major depressive disorder (Emslie et al., 2008; Kennard et al., 2008). Study participants were referred from advertisements, clinician or school counselors, and other sources. To date, two studies have examined referral source as a predictor of treatment outcome in youth with MDD, each yielding a different result. Thus, the purpose of the current study was to determine whether referral source is a predictor of treatment outcome in children and adolescents with major depressive disorder. Characteristics of acute study participants including age, gender, ethnicity, severity and duration of illness, suicidal behaviors, and number of comorbid diagnoses were compared between participants from differing referral sources. The findings of this study suggest that referral source is not a predictor of treatment outcome in children and adolescents with major depressive disorder.Item Should Obese Patients be Denied Rehabilitation Resources for Chronic Disabling Occupational Musculoskeletal Disorders?(2005-08-11) Aceska, Aleksandra; Gatchel, Robert J.In the United States, obesity is a rising concern because of its effect on both physical and mental health. More than one-third of Americans are obese, and approximately 1% (5 million people) suffer from clinically severe obesity (Kolotkin, Meter & Williams, 2001). Little research has been provided on the effect of obesity on functional restoration rehabilitation for work-related chronic musculoskeletal pain patients. The purpose of this study was to determine whether obese individuals are as successful after completing a functional restoration program as those that are of normal weight. Subjects included 3,341 chronic musculoskeletal patients from the Productive Rehabilitation Institute of Dallas for Ergonomics (PRIDE) who were separated in five BMI categories: Normal, Overweight, Obese I, Obese II, and Obese III. For the purposes of this study, the above weight categories were determined by using the body mass index formula: weight in kg/height in m.2 These subjects were evaluated on demographic, physical, psychosocial and one-year socioeconomic variables, with respect to the five BMI categories. The results showed some significant differences in terms of age, gender, and race. Injury related variables, however, were found to be nonsignificant. Significant difference was also found in the physical and psychosocial variables, in terms of disability level, physical functioning and pain intensity. Obese subjects were found to have a higher disability level, lower physical functioning, and higher pain intensity, pre- or post-treatment. In contrast, the results also suggest that the Obese III group improved pre- to post-treatment at the same rate as the other groups. Significant differences were also found in work return among the five groups; however, the linear trend analysis was found to be nonsignificant. This means that the Obese III group was not less likely to return to work than any of the other groups. Work retention, employment status, and hours worked per week did not result in any significant difference among the five groups. It can be concluded from this study that obese individuals are as successful as non obese individuals in returning to normal functioning after functional restoration rehabilitation.Item Statistical Analysis of Proposed Pediatric Asthma Screening Survey(2005-04-15) Alexander, John C.; Oeffinger, Kevin C.Background: Poor asthma control is responsible for considerable morbidity and mortality among children (1). Current pharmacotherapy can suppress exacerbations of asthma symptoms. Thus, proper treatment of asthma is imperative in limiting the toll of this disease process on individuals as well as society. Treatment protocols tend to be based on measurement of asthma severity (3), but there are currently no widely accepted guidelines defining efficacy of treatment (i.e.- asthma control). Objective: This study aimed to assess the construct validity and reliability of an asthma survey among a group of known asthmatics. Furthermore, we intended to determine the level of correlation between survey responses and asthma severity amongst survey participants as well as to discern the ability of the survey to discriminate between mild persistent, moderate persistent and severe persistent asthma. Methods: Surveys from 207 parents/guardians of children aged 5-17 with physician-diagnosed asthma were evaluated for construct validity using Principal Components Factor Analysis. Reliability was assessed via Cronbach's alpha coefficient scale. Severity/response correlations were tested by Chi-square exact tests and the strength of each relationship was assessed using Spearman's correlation. Discriminating ability was analyzed by ROC curve, sensitivity, specificity and odds ratio. Results: Construct validity testing showed that the scale is unidimensional with a Cronbach's alpha coefficient of 0.8076, indicating a high degree of reliability. Significant associations between asthma severity and each question were found, indicating that more severe asthmatics reported significantly greater symptom frequency (p-value range <0.001 - 0.019, Spearman's range = 0.152 - 0.396). ROC analysis yielded an area under the curve of 0.728. Analysis of the ROC curve indicated an optimal cutoff score of =6 to indicate moderate-to-severe asthma. This cutoff yielded a sensitivity and specificity of 65.2% and 70.2%, respectively. Odds ratio was 4.407 (95% CI of 2.366 - 8.207). Conclusion: Our results indicate that, among asthmatics, the survey is valid and reliable. We also noted more frequent symptoms as severity increased, indicating sub-optimal control among more severe asthmatics. Finally, the ability of the survey to predict asthma severity is not supported as the survey seems to assess asthma control, with higher scores indicating poorer control.Item Successful Long-Term Outcomes of Previously Transitionally-Housed Female-Headed Families(2005-08-11) Moore-Betasso, Melody; Evans, H. MontyDespite efforts on the part of federal, state, and local government as well as concerned community organizations, homelessness, especially among female-headed families, has continued to increase. Despite the need for outcome studies and an increased understanding of how to serve these families, few research studies have attempted to determine what factors contribute to long-term success. The current study explored the impacts of therapy, substance abuse, domestic violence, mental illness, and social support on long-term success for women who were previously transitionally housed. In addition, the children's self-esteem, self-efficacy, substance abuse, and mental illness were also taken into account. Success was defined as either six months or more stable housing or six months or more stable employment. The majority of the participants met criteria for success by at least one definition, and half of the participants were successful by both definitions. It was found that the optimal length of stay in a transitional housing center is one year, with longer stays being less likely to contribute to permanent housing. Women who were successfully housed reported more psychological symptoms than those who were not, identifying the need for follow-up services for past-residents of shelters and transitional housing centers, who are likely experiencing increased stress as they attempt to live independently. Overall, there was a low prevalence of substance abuse among both women and children. Further, children were not found to be likely to report psychological symptoms. Children whose mothers were successfully housed were found to have greater personal and social self-esteem as well as consider academics more important than those whose mothers were not successfully housed. The results of the current study indicate the effectiveness of a specific transitional housing center located in Dallas, Texas, the Shared Housing Center.Item Validation of a Neuropsychological Wada Procedure(2005-08-11) Eisenman, Daniel David; Lacritz, LauraThe Intracarotid amobarbital procedure (IAP) is considered an essential part of the presurgical neurodiagnostic evaluation in most epilepsy centers throughout the country. Despite the IAP's mainstream use, there is great variability in how the test is being performed across centers. The main purpose of this study was to validate a standardized IAP memory measure and explore its value in predicting lateralization as well as treatment outcome. The IAP memory measure had good overall reliability for all three Forms (Cronbach's Alpha = .85 for Form I, .83 for Form II, and .69 for Form III). The majority of items on Form I and II had acceptable item difficulty values, item discrimination values, and item-total correlations. There were a few items on Forms I and II that may be candidates for revision, but most items were only slightly below predicted ranges for what defines a "good" measure, and the majority of items contributed to the reliability of the test. In terms of construct validity, correlations with other memory tests provided some evidence of convergent validity for the IAP memory measure, but were generally low. In terms of divergent validity, both Forms I and II had low or no correlations with the executive functioning measures, providing preliminary support for the construct validity of the measure. When utilizing a discrepancy score to predict lateralization in subjects with temporal lobe epilepsy, asymmetry scores from the IAP memory measure were able to classify 92% of subjects with either left or right TLE after applying a correction factor for left injection scores. There was limited data regarding post-operative seizure outcome. However, seizure-free subjects had a higher percentage of DS greater than 20% than those subjects who reported at least one seizure postoperatively. In addition, there was a significant difference on Form I of the IAP memory measure between subjects who reported they were seizure free following temporal resection as compared to subjects who continued to report symptoms. Overall, the IAP memory measure demonstrated good psychometric properties and this study represents one of the most thorough analyses of the IAP memory test to date.