Home-based family intervention for low-income children with asthma: a randomized controlled pilot study

Low-income African American children have disproportionately higher asthma morbidity and mortality. Education alone may not address barriers to asthma management due to psychosocial stress. This study evaluated the efficacy of a home-based family intervention integrating asthma education and strategies to address stress using a community-based participatory research model. Children age 8 to 13 with poorly controlled asthma and their caregivers were recruited from an urban hospital and an asthma camp. Caregivers with elevated scores on a stress measure were enrolled. Forty-three families were randomized to the 4- to 6-session Home Based Family Intervention (HBFI) or the single session of Enhanced Treatment as Usual (ETAU). All families received an asthma action plan and dust mite covers; children performed spirometry and demonstrated MDI/spacer technique at each home visit. The HBFI addressed family-selected goals targeting asthma management and stressors. Asthma management, morbidity, family functioning, and caregiver stress were assessed at baseline, postintervention, and 6 months after the intervention. ED visits and hospitalizations were ascertained by medical record review for a year after intervention completion. Only one child (5%) in HBFI had an asthma-related hospitalization compared to 7 patients (35%) in ETAU in the year following intervention. Participants in both groups demonstrated improved asthma management and family functioning, and reduced ED visits, symptom days, missed school days, and caregiver stress, but there were no differential treatment effects. The results suggest that a home-based intervention addressing medical and psychosocial needs may prevent hospitalizations for children with poorly controlled asthma and caregivers under stress.     

9-24月龄婴儿母亲敏感性的预防性干预实验

本研究根据依恋理论和相关的干预研究成果编制了母亲敏感性干预手册,并对9-24月龄要儿的母亲实施了预防性干预.有16对母婴对分别进行了家庭录像观察.其中10位母亲作为培训组参加为期两个月的干预,干预目标集中于提高母亲敏感性,并提高母亲与婴儿的互动行为水平.另外6位母亲为对照组.三个月后,干预完成并再次对培训组和对照组进行家庭观察.用AinSwonh母亲敏感性量表和母亲行为Q分类方法分别对两次家庭观察录像进行编码分析.结果表明:培训组在信号敏感、可得、阻碍和接纳四个方面都有改善;该干预模式有效提高了母亲的敏感性.同时,该干预对母婴互动行为水平也略有提高.在文章中讨论了存在的问题和今后的研究方向.     

Implementation and Assessment of an Empirically Validated Intervention Program to Prevent Tobacco Use Among African-American Middle-School Youth

Evaluated Project Towards No Tobacco Use (TNT), a tobacco-use prevention program delivered in schools with primarily African-American students. Students were assigned randomly by classroom to either the intervention (n=58) or to a no-treatment control group (n=40). Students in the intervention group received a curriculum-based program over the course of 10 sessions. Pre-and post-assessments of tobacco knowledge, attitudes, communication, peer refusal, and smoking tendency were gathered. Students in the intervention group differed from their peers in the control group by evidencing greater knowledge and communication skills. We found this tobacco-use prevention program useful for African-American students.This investigation was supported in full by the American Cancer Society Grant Award ACS IRG 97-151.     

Interventions for caregivers of older and dependent adults: a review

Studies of intervention for caregivers of older and dependent relatives are reviewed. National (PortalMayores, Psicodoc, Psyke) and international (Ageline, Cochrane Library, Medline, Psycinfo) databases were searched for randomized studies, published from 1980 to 2004, that attempt to reduce emotional distress in caregivers. Most intervention studies focus on caregivers of dementia patients and these caregivers are usually females. Caregivers are not an easy group to access. Intervention objectives and contents vary widely and they are not always well defined. The reported effects are moderate. Studies achieve significant outcomes in reducing distress from behavioural problems, but it is difficult to improve depression levels. Psychotherapeutic interventions have shown moderate efficacy. To conclude, future intervention studies should determine the theoretical framework clearly, as well as the goals, and should use more extensive followup periods.     

Effects of a Workplace Intervention on Parent–Child Relationships

This study tested whether effects of a workplace intervention, aimed at promoting employees’ schedule control and supervisor support for personal and family life, had implications for parent–adolescent relationships; we also tested whether parent–child relationships differed as a function of how many intervention program sessions participants attended. Data came from a group randomized trial of a workplace intervention, delivered in the information technology division of a Fortune 500 company. Analyses focused on 125 parent–adolescent dyads that completed baseline and 12-month follow-up home interviews. Results revealed no main effects of the intervention, but children of employees who attended 75 % or more program sessions reported more time with their parent and more parent education involvement compared to adolescents whose parents attended <75 % of sessions, and they tended to report more time with parent and more parental solicitation of information about their experiences compared to adolescents whose parents were randomly assigned to the usual practice condition.     

Problem-solving training for family caregivers of women with disabilities: A randomized clinical trial

ObjectiveTo examine the effectiveness of an individualized problem-solving intervention provided to family caregivers of women living with severe disabilities.DesignFamily caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year.ParticipantsFamily caregivers (64 women, 17 men) and their care recipients (81 women with various disabilities) consented to participate.Main outcome measuresCaregivers completed the Social Problem-Solving Inventory – Revised, the Center for Epidemiological Studies Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in three additional assessments throughout the year.ResultsMultilevel modeling was used to conduct intent-to-treat analyses of change trajectories for each outcome variable. Caregivers who received PST reported a significant linear decrease in depression over time; no effects were observed for caregiver health or life satisfaction. Caregivers who received PST also displayed an increase in constructive problem-solving styles over the year.ConclusionsPST may benefit community-residing family caregivers of women with disabilities, and it may be effectively provided in home-based sessions that include face-to-face visits and telephone sessions.     

Caregiving for children through conflict and displacement: a pilot study testing the feasibility of delivering and evaluating a light touch parenting intervention for caregivers in the West Bank

A child's adjustment to wartime stress is reliant not only on individual responses and qualities, but very significantly on the availability of support that they may receive from their parent or caregivers and quality of relationships. Strengthening parental support has the potential to be valuable. A pilot two-arm randomised controlled trial investigated the feasibility of delivering and evaluating the “Caring for Children Through Conflict and Displacement” intervention with caregivers in the West Bank. Feasibility to recruit and train non-specialist staff on-the-ground to screen families for eligibility, collect outcome data, deliver the intervention and to recruit and retain families in the study were examined. Research staff and intervention facilitators were successfully appointed in the field, screened participants and delivered the intervention to 120 caregivers, collecting outcome measures pre-and post-delivery. All families completed the outcome measures, with very little missing data. This indicated that the intervention can be delivered feasibly and evaluated with families in this humanitarian context. Preliminary outcome data showed promise that the intervention may have the potential to both improve family functioning and reduce children's problem behaviour. Implications of family-focused initiatives, particularly within a conflict/post-conflict context for the prevention of several negative health and social outcomes directions, are discussed.     

The effectiveness of a peer-helping programme that increases subjective well-being

The present study aims to investigate the effectiveness of a peer-helping programme in increasing the subjective well-being of a group of university students compared with a control group with the same characteristics who did not receive the intervention. The intervention recipients consisted of 13 male and 17 female participants. The peer helpers were 22 female and 8 male participants. The peer-helping programme consisted of three stages: training in helping skills, implementation and facilitating supervision sessions. The short-term effects of the programme were investigated using the Positive and Negative Affect Scale. The programme's long-term effects were evaluated using the Life Satisfaction Scale and the Positive and Negative Affect Schedule. The results indicated that the short-term subjective well-being effects of the intervention activities were statistically significant. Additionally, the results revealed statistically significant increases in positive affect and life satisfaction and significant decreases in negative affect in the intervention group compared with that in the control group. Peer-helping programme may be used to increase individuals’ subjective well-being.     

Incorporating family therapy into asthma group intervention: a randomized waitlist-controlled trial

Asthma psychoeducational programs have been found to be effective in terms of symptom-related outcome. They are mostly illness-focused, and pay minimal attention to systemic/familial factors. This study evaluated a novel asthma psychoeducation program that adopted a parallel group design and incorporated family therapy. A randomized waitlist-controlled crossover clinical trial design was adopted. Children with stable asthma and their parents were recruited from a pediatric chest clinic. Outcome measures included, for the patients: exhaled nitric oxide (eNO), spirometry, and adjustment to asthma; and for the parents: perceived efficacy in asthma management, Hospital Anxiety and Depression Scale anxiety subscale, Body Mind Spirit Well-being Inventory emotion subscale, and Short Form 12 health-related quality of life scale. Forty-six patients participated in the study. Attrition rates were 13.0% and 26.0% for the active and control groups, respectively. Repeated-measures ANOVA revealed a significant decrease in airway inflammation, as indicated by eNO levels, and an increase in patient's adjustment to asthma and parents' perceived efficacy in asthma management. Serial trend analysis revealed that most psychosocial measures continued to progress steadily after intervention. Significant improvements in both symptom-related measures and mental health and relationship measures were observed. The findings supported the value of incorporating family therapy into asthma psychoeducation programs.     

The Love and Fear of Flying by Douglas D. Bond

A study of over 700 referrals for group therapy within a large university hospital setting revealed that such services were primarily provided for moderately to severely disturbed patients, mostly single white females from working and middle class backgrounds, university students, and unemployed, poorly educated minority group members. However, 41 percent of the patients initially referred never actually attended a therapy group. Among those who did begin group therapy, drop-outs occurred most frequently during early sessions. Over half the treated patients were seen for a total of twelve or fewer sessions. Data are interpreted as highlighting the importance of implementing careful referral and preparation procedures, and as underscoring the necessity for developing effective short-term group therapy approaches.     

The Nurturing Program: An Intervention for Parents of Children with Special Needs

Evidence-based psychosocial family interventions enhancing empathy and empowerment are particularly beneficial to families of children who have developmental disabilities. This study assessed the effectiveness of an intervention called the Nurturing Program for Parents and Their Children with Special Needs and Health Challenges (SNHC). Eighty-seven families were enrolled and randomly assigned to a control or treatment group. Forty-six families in the control group received individualized case management (CM) services and forty-one families in the treatment group were assigned to 12 sessions of the SNHC curriculum along with case management services. Before and after the intervention, participants in both conditions completed the Adult and Adolescent Parenting Index-2 assessing parents’ attitudes toward child rearing and the Family Empowerment Scale (FES) measuring family empowerment. Caregivers in the intervention condition improved in empathy towards children’s needs, F(1, 54)?=?4.52, p?=?.04; and all families, both control group and treatment group, improved their attitudes towards the use of corporal punishment by posttest, F(1, 54)?=?6.56, p?=?.013. Also, all caregivers increased in their empowerment over the course of the intervention, F(1, 50)?=?13.28, p?=?.001. Attrition, 22–26% among CM and 51–56% among SNHC+CM, limited generalizability as did participants not completing all SNHC sessions. Despite these limitations, findings suggest that early interventions catering to families of children with developmental disabilities have a positive impact on parenting. To varying degrees, both conditions provided caregivers with tools that positively affected the quality of the parent–child relationships and promoted empowerment.     

Teachers' attunement to students' peer group affiliations as a source of improved student experiences of the school social-affective context following the middle school transition

A randomized control trial examined the impact of a professional development program on rural teachers' attunement to student social dynamics, and the influence of teacher attunement on students' school experiences. In intervention schools serving Latino and White rural early adolescents, teachers (N = 14) received training on social dynamics and aspects of early adolescent adjustment; control school teachers (N = 12) received no training. Social cognitive mapping procedures assessed and compared students' and teachers' perceptions of peer groups; structured observations assessed teachers' management of social dynamics. Students (N = 225) self-reported their perceptions of the school social-affective context. Intervention and control schools differed on teacher attunement and management of the social environment. Students whose teachers were more attuned to peer group affiliations evidenced improved views of the school social environment. Findings are discussed in terms of attunement as an element of teachers' invisible hand, and for teachers' role in promoting productive contexts for students during the middle school transition.     

A preliminary study of a traumatic injury prevention program

Abstract

This study examined the long-term impact of a five component spinal cord injury prevention program presented to adolescents. A sample of 445 teenagers who attended a junior high school in which an educational intervention was presented three years earlier and a control group of 379 students who had not been exposed to the intervention completed a questionnaire assessing their safety knowledge, attitudes, and self-reported behaviors. Total scores on the questionnaire between treatment and control groups differed significantly. Students in the treatment group reported significantly more frequent seat belt use, stronger belief that seat belts were important to their safety, lower likelihood of riding with friends who had been drinking, higher rates of friends' use of seat belts, greater awareness of the age group most likely to be injured, and increased knowledge that they could prevent spinal cord injury.     

Suicide survivors seeking mental health services: a preliminary examination of the role of an active postvention model

Archival data from suicide survivors presenting for treatment from 1999-2005 at the Baton Rouge Crisis Intervention Center (BRCIC) were used to examine differences in those who received an active model of postvention (APM; n=150) compared to those who received a traditional passive postvention (PP, n=206). APM presented sooner for treatment (48 days) than PP (97 days). APM survivors were more likely to have been the survivor of a violent suicide. APM were more likely than PP to attend survivor support group meetings and APM attended more groups. To better understand the efficacy of APM in helping survivors, a prospective evaluation is needed.     

Problem-solving training via videoconferencing for family caregivers of persons with spinal cord injuries: a randomized controlled trial

Objective

To examine the effectiveness of an individualized problem-solving intervention delivered in videoconferencing sessions with family caregivers of persons living with a spinal cord injury (SCI) and possible contagion effects on care recipients.

Design

Family caregivers were randomly assigned to an education-only control group or an intervention group in which participants received problem-solving training (PST) in monthly videoconference session for a year.

Participants

Sixty-one caregivers (54 women, 7 men) and their care recipients (40 men, 21 women) consented to participate.

Main outcome measures

The Social Problem-Solving Inventory-Revised was administered to caregivers. Caregivers and care recipients completed the Inventory to Diagnose Depression, the SF-36 and the Satisfaction with Life scale at pre-treatment, 6 months and 12 months.

Results

Twenty-eight caregivers discontinued the study and their follow-up data were unavailable at the final assessment. Older caregivers were more likely than younger caregivers to remain in the study. Intent-to-treat analyses projected a significant decrease in depression among caregivers receiving PST; efficacy analyses indicated this effect was pronounced at the 6th month assessment. ITT analyses and efficacy analyses revealed that care recipients of caregivers receiving PST reported gains in social functioning over time.

Conclusions

Community-based, telehealth interventions may benefit family caregivers and their care recipients, but the mechanisms of these effects are unclear. Attrition and sample issues should be considered in future studies with these populations.     

Acceptability and feasibility of a brief substance use intervention for adolescents in Cape Town,South Africa: A pilot study

Substance use is prevalent among South African adolescents, but few interventions exist to reduce risk of harm. This study assesses the feasibility, acceptability and preliminary effects of a brief intervention for reducing adolescent substance use and other risk behaviours. This single-arm feasibility test recruited 30 substance-using adolescents and their primary caregiver. Participants received separate interventions (2 sessions for adolescents, 1 session for caregivers), with a subsample randomly selected for post-intervention interviews. Feasibility was measured by the proportion of eligible adolescents who were enrolled and retained in the study. Interviews explored acceptability, and changes in outcomes from baseline to 1-month follow-up assessed preliminary effects of the intervention. Thirty of 43 (69.8%) eligible adolescents and their caregivers were enrolled, with 29 adolescents (96.7%) and 28 caregivers (93.3%) completing the intervention. Twenty-eight adolescents (93.3%) and 29 caregivers (96.7%) were retained at follow-up. Frequency of alcohol, cannabis use and delinquent-type behaviours decreased significantly from baseline to follow-up. Participants appreciated the intervention content and delivery and felt that it facilitated behaviour change. Suggestions for improving the intervention were provided. This study found that the intervention is feasible, acceptable and had promising effects on adolescent behaviour. Efficacy must be established with a randomised controlled trial.     

Preventing conduct problems, promoting social competence: a parent and teacher training partnership in head start

Studied the effectiveness of parent and teacher training as a selective prevention program for 272 Head Start mothers and their 4-year-old children and 61 Head Start teachers. Fourteen Head Start centers (34 classrooms) were randomly assigned to (a) an experimental condition in which parents, teachers, and family service workers participated in the prevention program (Incredible Years) or (b) a control condition consisting of the regular Head Start program. Assessments included teacher and parent reports of child behavior and independent observations at home and at school. Construct scores combining observational and report data were calculated for negative and positive parenting style, parent-teacher bonding, child conduct problems at home and at school, and teacher classroom management style. Following the 12-session weekly program, experimental mothers had significantly lower negative parenting and significantly higher positive parenting scores than control mothers. Parent-teacher bonding was significantly higher for experimental than for control mothers. Experimental children showed significantly fewer conduct problems at school than control children. Children of mothers who attended 6 or more intervention sessions showed significantly fewer conduct problems at home than control children. Children who were the "highest risk" at baseline (high rates of noncompliant and aggressive behavior) showed more clinically significant reductions in these behaviors than high-risk control children. After training, experimental teachers showed significantly better classroom management skills than control teachers. One year later the experimental effects were maintained for parents who attended more than 6 groups. The clinically significant reductions in behavior problems for the highest risk experimental children were also maintained. Implications of this prevention program as a strategy for reducing risk factors leading to delinquency by promoting social competence, school readiness, and reducing conduct problems are discussed.     

Feasibility,Acceptability, and Preliminary Outcomes of the Fortalezas Familiares Intervention for Latino Families Facing Maternal Depression

This pilot study examined the feasibility, acceptability, and preliminary outcomes of a linguistically and culturally adapted intervention for immigrant Latina mothers with depression and their families. Fortalezas Familiares (Family Strengths) is a community‐based, 12‐week, multifamily group intervention that aims to increase communication about family processes leading up to and affected by the mother's depression, build child coping and efficacy, enhance parenting competence and skills, and promote cultural and social assets within the family. In terms of feasibility, of 16 families who enrolled and participated in the intervention, 13 families attended more than 90% of meetings and completed the intervention. Posttests reported positive changes following the intervention, including improved psychological functioning, increased family and marital support, and enhanced family functioning, as reported by mothers and other caregivers. Mothers also reported decreased conduct and hyperactivity problems among their children. Children reported positive changes in their psychological functioning and coping, parenting warmth and acceptance, and overall family functioning. Postintervention focus groups and surveys measuring acceptability revealed families' satisfaction with the intervention and suggested areas of improvement. We discuss similarities and differences in outcomes between the adapted intervention, Fortalezas Familiares, and the original intervention, Keeping Families Strong, and propose future areas of intervention adaptation and development.     

FIRST YEAR CAMPUS ACQUAINTANCE RAPE EDUCATION Evaluating the Impact of a Mandatory Intervention

The current study was designed to evaluate the impact of First Year Campus Acquaintance Rape Education (FYCARE), a mandatory program for first year undergraduates. First, questionnaires were administered to 48 FYCARE participants assessed immediately following workshop participation, 76 FYCARE participants sampled through the unrelated context of introductory psychology courses, and 67 students sampled through introductory psychology who had not yet attended their scheduled FYCARE workshop. Second, ostensibly unrelated telephone surveys were conducted with 93 students who participated in FYCARE 4 to 6 months earlier and 77 first year students who had not yet attended their scheduled workshop. Results indicated a positive impact of participation on attitudes and judgments of a hypothetical scenario, but only when assessed immediately following workshop participation. In contrast, increases in knowledge were maintained for a period of up to 7 weeks, and phone survey responses revealed an increase in the level of support for rape prevention efforts 4 to 6 months following program participation. Finally, superior outcomes were observed among students involved in more than one educational program, thus highlighting the need for repeated intervention.     

Prenatal intervention and support for low-income fathers

The focus of this study was to determine the effectiveness of prenatal intervention with low socioeconomic, first-time fathers whose partners were experiencing a high- or low-risk pregnancy. Of the 67 men, who were recruited by their partners, half were randomly assigned to participate in an intervention program designed to acquaint fathers-to-be with information, insights, and clinically appropriate techniques in responsive care for infants. Intervention group fathers received two intensive 1¹/₂-hour sessions emphasizing the nature and capabilities of the prebornhewborn and sensitive responsiveness to preborn/newborn cues and to partner cues. Postnatally, fathers were videotaped with their infants during two feeding interactions. At Time 1, intervention fathers were rated from videotapes as significantly more sensitive during feeding interactions with their newborn infants. At Time 2, 1 month later, differences between father groups approached significance.