The association between expressed emotion (EE) and psychiatric disorders was investigated in a community survey of 108 preadolescent children. Results indicated that the two components of EE, critical comments and emotional overinvolvement, identified non-overlapping subsets of families and displayed diagnostic specificity. Significantly higher rates of disruptive behavior diagnoses were observed in children of parents who expressed high levels of criticism, while children of parents who expressed high levels of emotional overinvolvement were significantly more likely to have an anxiety disorder when compared to the remaining sample. Findings support the utility of this brief measure of EE in epidemiologic samples.

Diversity is the one true thing we all have in common. Celebrate it every day.-Author UnknownThe 2002 Institute of Medicine (IOM) report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, brought into stark focus the issues of inequities based on minority status in health care services. The IOM report concluded that, "Bias, stereotyping, prejudice, and clinical uncertainty on the part of healthcare providers may contribute to racial and ethnic disparities in healthcare" (1). Persons in racial and ethnic minority groups were found to receive lower-quality health care than whites received, even when they were insured to the same degree and when other health care access-related factors, such as the ability to pay for care, were the same (1). Clients in minority groups were also not getting their needs met in mental health treatment (2, 3). The IOM report was a primary impetus for the cultural competence movement in health care. Cultural competency emphasizes the need for health care systems and providers to be aware of, and responsive to, patients' cultural perspectives and backgrounds (4). Patient and family preferences, values, cultural traditions, language, and socioeconomic conditions are respected. The concepts of cultural competence and patient-centered care intersect in meaningful ways. The IOM's Crossing the Quality Chasm (5) document defines patient-centered care as "providing care that is respectful of, and responsive to, individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions" (p. 3). Both patient centeredness and cultural competence are needed in striving to improve health care quality (6, 7). To deliver individualized, patient-centered care, a provider must consider patients' diversity of lifestyles, experience, and perspectives to collaborate in joint decision making. Patient-centered care has the potential to enhance equity in health care delivery; cultural sensitivity may likewise enhance patient-centered care (6). Indicators of culturally sensitive health care identified in focus groups of low-income African-American, Latino American, and European American primary care patients included interpersonal skills, individualized treatment,

Our findings revealed sociodemographic differences in psychopharmacological care among young Medicaid managed care enrollees and the common occurrence of multiple psychotropic pharmacotherapy.

CPS is a promising approach to reduce seclusion and restraint use in a child psychiatric inpatient setting. Future research and replication efforts are warranted to test its effectiveness in other restrictive settings.

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