Peer- and family-based group therapies have been used as separate interventions to improve adjustment and self-management among youth with Type 1 diabetes mellitus. This study replicates a treatment protocol that combined these two types of diabetes management groups, while also using a wait-list control design methodology within an outpatient mental health clinic setting. General psychosocial and diabetes-related variables were assessed at baseline, immediately posttreatment, and 4 months posttreatment. Youths' medical information, including metabolic control values, was extracted from medical charts for the 6 months prior to baseline and 6 months after treatment ended. At 4 months posttreatment, parents and youth reported increased parent responsibility, and parents reported improved youth diabetes-specific quality of life. Although there were no statistically significant changes in hemoglobin A1c values and health care utilization frequency from 6 months prior to and 6 months posttreatment, other psychosocial changes (i.e., increases in parent responsibility and diabetes-specific quality of life) were documented. Therefore, this treatment was found to be a promising intervention for use in an outpatient clinical setting to aid in improving the psychosocial functioning of youth with Type 1 diabetes mellitus.

We investigated the impact of alcohol-related medical emergencies on health care utilization in an inner city hospital medical intensive care unit (ICU). Data from 200 consecutive admissions to the medical ICU were collected prospectively. The major reason for each patient's admission to the ICU was recorded and the causal relationship between alcohol abuse and the admission diagnosis was determined. Clinical and demographic data as well as the insurance status and cost of goods and services delivered were determined for all patients. Twenty-one per cent of all the ICU admissions were directly alcohol-related, with a mean hospital charge of $52,527. The alcohol-withdrawal syndrome was the commonest alcohol-related admission, with a mean ICU stay of 5 days and a mean hospital charge of $21,336. Of the patients with non-alcohol related admission diagnoses, 61% had health insurance, compared to 42% for the patients with alcohol-related admission diagnoses (P < 0.05). Patients with alcohol-related admissions tended to be younger and male. In conclusion, we demonstrated that alcohol-related admissions are common in inner city hospital ICUs and consume considerable hospital resources. The treatment of these patients is costly, with hospitalization being essentially non-curative. In this era of health care reform, more effective primary and secondary preventative measures are required to control this pervasive health care problem.

Objective: Psychosocial issues associated with craniofacial diagnoses and the ongoing burden of care can impact the quality of life of patients and families, as well as treatment adherence and outcomes. Utilizing available literature and clinical expertise across 6 centers, the present article summarizes key psychosocial issues for the benefit of nonmental health medical providers and offers suggestions as to how all members of craniofacial teams can promote positive psychosocial outcomes. Results: Family adjustment across developmental phases is outlined, with strategies to support adaptive parental coping. Teasing is a common concern in craniofacial populations and medical providers can promote coping and social skills, as well as link families to mental health services when needed. Academic issues are described, alongside suggestions for medical providers to assist families with school advocacy and ensure access to appropriate services within the school setting. Medical providers are key in preparing patients and families for surgery, including consideration of medical, social, and logistical supports and barriers. As craniofacial care spans infancy to adulthood, medical providers are instrumental in assisting patients and families to navigate treatment transition periods. In addition to ongoing clinical team assessments, medical providers may utilize screening measures to identify and track patient and family adjustment in multiple areas of team care. Conclusions: Multidisciplinary providers play an important role in supporting positive adjustment in patients affected by craniofacial conditions and their families.