Objective:To test effectiveness of the Early Detection, Intervention, and Prevention of Psychosis Program in preventing the onset of severe psychosis and improving functioning in a national sample of at-risk youth.Methods:In a risk-based allocation study design, 337 youth (age 12–25) at risk of psychosis were assigned to treatment groups based on severity of positive symptoms. Those at clinically higher risk (CHR) or having an early first episode of psychosis (EFEP) were assigned to receive Family-aided Assertive Community Treatment (FACT); those at clinically lower risk (CLR) were assigned to receive community care. Between-groups differences on outcome variables were adjusted statistically according to regression-discontinuity procedures and evaluated using the Global Test Procedure that combined all symptom and functional measures.Results:A total of 337 young people (mean age: 16.6) were assigned to the treatment group (CHR + EFEP, n = 250) or comparison group (CLR, n = 87). On the primary variable, positive symptoms, after 2 years FACT, were superior to community care (2 df, p < .0001) for both CHR (p = .0034) and EFEP (p < .0001) subgroups. Rates of conversion (6.3% CHR vs 2.3% CLR) and first negative event (25% CHR vs 22% CLR) were low but did not differ. FACT was superior in the Global Test (p = .0007; p = .024 for CHR and p = .0002 for EFEP, vs CLR) and in improvement in participation in work and school (p = .025).Conclusion:FACT is effective in improving positive, negative, disorganized and general symptoms, Global Assessment of Functioning, work and school participation and global outcome in youth at risk for, or experiencing very early, psychosis.

The challenges of ensuring access to quality care for this population are magnified by provider discourses of "therapeutic neutrality."

Although persons from sexual and gender minority groups often experience positive outcomes as a result of help seeking, some LGBT people remain vulnerable to anti-LGBT sentiments that persist within secular and sacred sectors of rural health care systems.

PURPOSE Primary care clinicians will continue to play an important role in cervical cancer prevention, particularly with regard to administration of the newly licensed human papillomavirus (HPV) vaccine and continued administration of Papanicolaou tests. Little is known about the factors that infl uence cervical cancer prevention counseling, particularly in the adolescent encounter. We conducted a qualitative study to better understand the implications for counseling about cervical cancer prevention by primary care clinicians who care for adolescents. METHODSWe conducted in-depth interviews with 37 primary care clinicians in New Mexico to understand the context in which they provide anticipatory guidance about sexual health risks as well as their attitudes about counseling for the forthcoming HPV vaccine. RESULTSClinicians identifi ed 4 categories of factors related to their counseling experiences with adolescents about HPV: (1) the need to build rapport with adolescent patients, (2) the presumption that adolescent patients engage in high-risk behaviors, (3) the situational delivery and complexity of HPV counseling, and (4) perceptions of clinician and community receptivity to the HPV vaccine.CONCLUSION Our fi ndings show that conditions of the preadolescent and young adolescent visit pose a challenge to the successful integration of counseling about cervical cancer prevention in primary care. Counseling strategies that are designed to emphasize a preventive focus while including parents in the discussion at the time of vaccination and that are appropriate to populations with different cultural values and beliefs will help to enhance communication about cervical cancer prevention and the particular role of the HPV vaccine. 2007;5:298-304. DOI: 10.1370/afm.723. Ann Fam Med INTRODUCTIONH uman papillomavirus (HPV) ranks as the most commonly acquired sexually transmitted infection in the United States, and infection with HPV is linked to cervical cancer and genital warts.1,2 In June 2006, the fi rst HPV vaccine (Merck) was approved for females aged 9 to 26 years. 3 Shortly after its approval, the National Advisory Committee on Immunization Practices recommended that the vaccine be given to girls aged 11 to 12 years. 4 The approval of the HPV vaccine marks the beginning of a new stage in preventing sexually transmitted diseases (STDs) and their sequelae, in this case cervical cancer. Currently, the hepatitis B vaccine, administered during infancy, is the only existing vaccine that prevents a sexually transmitted disease, although several other STD vaccines are in various stages of development. 3,[5][6] Collectively, these vaccines have the potential to serve as powerful disease prevention weapons against chronic illnesses, including cancer. The availability of these vaccines will have important implicaAndrew L. Sussman, PhD 299CERVIC A L C A NCER PR EVENT ION COUNSELING tions for adolescents who, because they are at higher risk for contracting these diseases, will likely be the targeted recipients for these...

The findings suggest improvement in competency and professional practice scores in residents who participated in this course. This points toward the overall usefulness of the course and suggests that a process-oriented approach may be effective for discussing religion and spirituality in psychiatric training.