Following a suicide attempt by female adolescents, the impact of a specialized emergency room (ER) care intervention was evaluated over the subsequent 18 months. Using a quasi-experimental design, this study assigned 140 female adolescent suicide attempters (SA), ages 12-18 years, and their mothers (88% Hispanic) to receive during their ER visit either: (a) specialized ER care aimed at enhancing adherence to outpatient therapy by providing a soap opera video regarding suicidality, a family therapy session, and staff training; or (b) standard ER care. The adjustment of the SA and their mothers was evaluated over 18 months (follow-up, 92%) using linear mixed model regression analyses. SA's adjustment improved over time on most mental health indices. Rates of suicide reattempts (12.4%) and suicidal reideation (29.8%) were lower than anticipated and similar across ER conditions. The specialized ER care condition was associated with significantly lower depression scores by the SA and lower maternal ratings on family cohesion. Significant interactions of intervention condition with the SA's initial level of psychiatric symptomatology indicated that the intervention's impact was greatest on maternal emotional distress and family cohesion among SA who were highly symptomatic. SA's attendance at therapy sessions following the ER visit was significantly associated with only one outcome-family adaptability. Specialized ER interventions may have substantial and sustained impact over time, particularly for the parents of youth with high psychiatric symptomatology. Adolescent suicide attempts are a significant problem, with 7.7% of high school students reporting attempts and 2.6% saying their attempt required medical attention (Centers for Disease Control and Prevention [CDC], 1998). Adolescent suicide attempters (SA) are at increased risk for repeat attempts, long-term psychiatric symptoms, and academic, social, and behavioral problems (Shaffer & Piacentini, 1994). In spite of their great need for mental health intervention, fewer than 50% of adolescent attempters are referred for psychotherapy following their emergency room (ER) visit (Piacentini et al., 1995; Spirito, Brown, Overholser, & Fritz, 1989), and a large proportion of these individuals fail to attend their initial treatment session. Of those who do attend, many do not complete treatment (Piacentini et al., 1995; Spirito et al., 1989). Nonattendance to follow-up treatment by suicidal adolescents is especially disturbing, considering that psychiatric intervention can reduce subsequent attempts and social maladjustment (Rotheram-Borus, Piacentini, Miller, Graae, & Castro-Bianco, 1994; Shaffer & Piacentini, 1994). There are many reasons why individuals fail to attend treatment following an ER visit for a suicide attempt. Repetitive evaluations, lengthy waiting periods, bureaucratic registration procedures, and

It is common for longitudinal clinical trials to face problems of item non-response, unit non-response, and drop-out. In this paper, we compare two alternative methods of handling multivariate incomplete data across a baseline assessment and three follow-up time points in a multi-centre randomized controlled trial of a disease management programme for late-life depression. One approach combines hot-deck (HD) multiple imputation using a predictive mean matching method for item non-response and the approximate Bayesian bootstrap for unit non-response. A second method is based on a multivariate normal (MVN) model using PROC MI in SAS software V8.2. These two methods are contrasted with a last observation carried forward (LOCF) technique and available-case (AC) analysis in a simulation study where replicate analyses are performed on subsets of the originally complete cases. Missing-data patterns were simulated to be consistent with missing-data patterns found in the originally incomplete cases, and observed complete data means were taken to be the targets of estimation. Not surprisingly, the LOCF and AC methods had poor coverage properties for many of the variables evaluated. Multiple imputation under the MVN model performed well for most variables but produced less than nominal coverage for variables with highly skewed distributions. The HD method consistently produced close to nominal coverage, with interval widths that were roughly 7 per cent larger on average than those produced from the MVN model.

Runaway youth are 6-12 times more likely to become infected with HIV than other youth. Using a quasi-experimental design, the efficacy of an HIV prevention program was evaluated over 2 years among 2 groups of runaways: (1) those at 2 shelters who received Street Smart, an intensive HIV intervention program, and (2) youth at 2 control shelters. Street Smart provided youth with access to health care and condoms and delivered a 10-session skill-focused prevention program based on social learning theory to youth. Prior to analysis of the intervention's outcomes, propensity scores were used to identify comparable subgroups of youth in the intervention (n = 101) and control conditions (n = 86). Compared to females in the control condition, females in the intervention condition significantly reduced their unprotected sexual acts at 2 years and alcohol use, marijuana use, and the number of drugs used over 12 months. Male adolescents in the intervention condition showed significant reductions in marijuana use over 6 months compared to control youth. Adolescent HIV prevention programs must proactively identify mechanisms for maintaining behavior change over the long-term, and innovative research designs are needed to allow examination of agency-level interventions.

Cognitive behavioral intervention programs can effectively reduce the potential of HIV transmission to others among PLH who report significant transmission risk behavior.

The longitudinal impact of a family-based intervention on grandchildren of parents with HIV (PWH) is evaluated. Because PWH and their daughters demonstrated gains over 6 years when randomized to a coping skills intervention compared with a control condition, the adjustment of the PWH's grandchildren was also compared across conditions. Grandchildren in the intervention condition reported significantly fewer internalizing and externalizing behavioral symptoms compared with grandchildren in the control condition. There is weak evidence that grandchildren in the intervention condition had higher scores on measures of cognitive development and more positive home environments. These results suggest that there are possibly long-term, intergenerational benefits of an intervention for families coping with HIV.