Runaway youth report a broader range and higher severity of substance-related, mental health and family problems relative to non-runaway youth. Most studies to date have collected self-report data on the family and social history; virtually no research has examined treatment effectiveness with this population. This study is a treatment development project in which 124 runaway youth were randomly assigned to 1) Ecologically-Based Family Therapy (EBFT) or 2) Service as Usual (SAU) through a shelter. Youth completed an intake, posttreatment, 6 and 12 month follow-up assessment. Youth assigned to EBFT reported greater reductions in overall substance abuse compared to youth assigned to SAU while other problem areas improved in both conditions. Findings suggest that EBFT is an efficacious intervention for this relatively severe population of youth.

Comprehensive intervention for homeless, street living youth that addresses substance use, social stability, physical and mental health issues has received very little attention. In this study, street living youth aged 14 to 22 were recruited from a drop-in center and randomly assigned the Community Reinforcement Approach (CRA) or treatment as usual (TAU) through a drop-in center. Findings showed that youth assigned to CRA, compared to TAU, reported significantly reduced substance use (37% v. 17% reduction), depression (40% v. 23%) and increased social stability (58% v. 13%). Youth in both conditions improved in many other behavioral domains including substance use, internalizing and externalizing problems, and emotion and task oriented coping. This study indicates that homeless youth can be engaged into treatment and respond favorably to intervention efforts. However, more treatment development research is needed to address the barriers associated with serving these youth. Keywordshomelessness; adolescents; substance abuse; treatment; community reinforcement approach (CRA) Treatment Outcome for Street-Living, Homeless YouthAlthough research focusing on chronic runaways and homeless youth is increasing, there is a void of treatment evaluation studies with this group. Clements, Gleghorn, Garcia, Katz, and Marx (1997) note the importance of examining street based youth as separate from more stable, shelter residing youth given the higher levels of risk behaviors among street living youth. Street living youth often do not access other institutional settings (shelters, foster care, treatment centers) or family for assistance because these systems are not perceived to meet their needs (Marshall & Bhugra, 1996). In sum, differences among street living and shelter residing youth suggest the need for different intervention foci. Different challenges are posed and different treatment strategies are needed when addressing substance use and motivation for change in a youth whose basic needs are met (shelter-residing youth) than for a youth who has trouble finding enough food to eat, a place to sleep and receiving needed medical care. Scope of the ProblemAlthough estimates are crude given that these youth do not make it into standard school or population surveys, estimates of the number of youth who leave home prematurely each year Corresponding Author Natasha Slesnick, Ph.D. Human Development and Family Science The Ohio State University 135 Campbell Hall; 1787 Neil Ave Columbus, OH 43210 Ph: 614-247-8469 FAX: 614-292-4365 Email: Slesnick.5@osu.edu 2 Using an inverse transformation of the use of hard drugs variables made the scores more normally distributed. The untransformed scores had a skewness of 1.82 and 3.02 and kurtosis of 2.49 and 8.65 for each of the assessment points (intake, 6mfu). The transformed scores skewness was 0.42 and 0.42 and kurtosis was -1.51 and -1.78 for each of the assessment points (intake, 6mfu).

Treatment evaluation for alcohol problem, runaway adolescents and their families is rare. This study recruited primary alcohol problem adolescents (N = 119) and their primary caretakers from two runaway shelters and assigned them to either: 1) home-based Ecologically-Based Family Therapy (EBFT), 2) office-based Functional Family Therapy (FFT), or 3) Service as Usual (SAU) through the shelter. Findings showed that both home-based EBFT and office-based FFT significantly reduced alcohol and drug use compared to SAU at 15-months post-baseline. Measures of family and adolescent functioning improved over time in all groups. However, significant differences among the home and office-based intervention were found for treatment engagement and moderators of outcome.

Background and Purose Disruption of the blood-brain barrier (BBB) has been proposed to be important in vascular cognitive impairment (VCI). Increased cerebrospinal fluid (CSF) albumin and contrast-enhanced MRI provide supporting evidence, but quantification of the BBB permeability in patients with VCI is lacking. Therefore, we acquired dynamic contrast-enhanced MRI (DCEMRI) to quantify BBB permeability in VCI. Method We studied 60 patients with suspected VCI. They had neurological and neuropsychological testing, permeability measurements with DCEMRI and lumbar puncture to measure albumin index (Qalb). Patients were separated clinically into subcortical ischemic vascular disease (SIVD), multiple and lacunar infarcts (MI/LAC), and leukoaraiosis (LA). Twenty volunteers were controls for the DCEMRI studies, and control CSF was obtained from 20 individuals undergoing spinal anesthesia for non-neurological problems. Results Thirty-six patients were classified as SIVD, 8 as MI/LAC and 9 as LA. The Qalb was significantly increased in the SIVD group compared to 20 controls. Permeabilities for the VCI patients measured by DCEMRI were significantly increased over controls (p<0.05). Patient age correlated with neither the BBB permeability nor Qalb. Highest Qalb values were seen in SIVD group (p<0.05), and were significantly increased over MI/LAC. Ki values were elevated over controls in SIVD, but were similar to MI/LAC. Conclusions There was abnormal permeability in white matter in patients with SIVD as shown by DCEMRI and Qalb. Future studies will be needed to determine the relationship of BBB damage and development of WMHs.

Kinematic analyses of reaching have suggested that the left hemisphere is dominant for controlling the open loop component of the movement, which is more dependent on motor programmes; and the right hemisphere is dominant for controlling the closed loop component, which is more dependent on sensory feedback. This open and closed loop hypothesis of hemispheric asymmetry would also predict that advance planning should be dependent on the left hemisphere, and on-line response modification, which defines closed loop processes, should be dependent on the right hemisphere. Using kinematic analyses of reaching in patients with left or right hemisphere damage (LHD or RHD), we examined the ability: (i) to plan reaching movements in advance by examining changes in reaction time (RT) when response amplitude and visual feedback were cued prior to the response; and (ii) to modify the response during implementation when target location changed at the RT. Performance was compared between the stroke groups, using the ipsilesional arm, and age-matched control groups using their right (RNC) or left (LNC) arm. Aiming movements to a target that moved once or twice, with the second step occurring at the RT, were performed with or without visual feedback of hand position. There were no deficits in advance planning in either stroke group, as evidenced by comparable group changes in RT with changes in amplitude and visual feedback. Response modification deficits were seen for the LHD group in secondary velocity only. In addition, LHD produced slower initial peak velocity with prolongation of the deceleration phase and faster secondary peak velocities, and the RHD group produced deficits in final error only. These differences are more consistent with the dynamic dominance hypothesis, which links left hemisphere specialization to movement trajectory control and right hemisphere specialization to position control, rather than to global deficits in open and closed loop processing.