INCREASING THE IMMUNIZATION OF PRESCHOOL CHILDREN; AN EVALUATION OF APPLIED COMMUNITY INTERVENTIONS

We evaluated the relative impact of four procedures designed to encourage parents to obtain immunizations for their children. In a public health setting, the families of 1,133 immunization-deficient preschool children were randomly assigned to six conditions: (a) a general prompt; (b) a more client-specific prompt; (c) a specific prompt and increased public health clinic access; (d) a specific prompt and monetary incentives; (e) contact control; and (f) no contact control. All interventions, except the general prompt, produced some evidence of improvement when compared with the control groups. The monetary incentive group revealed the largest effect, followed by the increased access group, specific prompt group, and general prompt group, respectively. The data suggest that relatively powerful and immediate effects on preschoolers' clinic attendance for immunization may be produced by monetary incentives in conjunction with client-specific prompts. However, client-specific prompts alone appear to be the most cost-effective of the interventions.     

BEHAVIORAL COMMUNITY PSYCHOLOGY: ENCOURAGING LOW-INCOME PARENTS TO SEEK DENTAL CARE FOR THEIR CHILDREN1

The present study examined the effectiveness and cost efficiency of three different techniques to encourage low-income rural parents to seek dental care for their children. The families of 51 children who needed immediate dental care (determined by dental screening at a local school) were placed into three matched groups and randomly assigned to the treatment conditions: One Prompt (Note Only), Three Prompt (Note, Telephone Contact, Home Visit), and One Prompt plus $5 Incentive. The Three Prompt and One Prompt plus $5 Incentive were significantly more effective in initiating dental visits than the Note-Only procedure. Not only was the One Prompt plus $5 Incentive technique effective in producing a slightly larger percentage of initial dental visits compared to the Three-Prompt technique, it also produced a significantly larger number of followup visits. Furthermore, the cost-effectiveness analysis showed the Incentive condition to be less costly than the Three-Prompt condition in encouraging initial dental visits.     

REDUCING NONCOMPLIANCE TO FOLLOW-UP APPOINTMENT KEEPING AT A FAMILY PRACTICE CENTER

In this study, we evaluated follow-up appointment keeping at a family practice center. To determine if noncompliance could be reduced, four treatments were implemented: no-treatment control, modified appointment card, free follow-up, and a reduced rate follow-up. Thereafter, the reduced rate follow-up was implemented again to determine the extent noncompliance could be reduced for all eligible patients. Incentives significantly increased follow-up appointment keeping, whereas the modified appointment card was ineffective. A cost analysis suggested that the no-treatment control and modified appointment card conditions were the least expensive, but also the least effective. The incentive conditions were more expensive, but the reduced rate condition generated the most net revenue. Questionnaire data suggested that the incentive conditions had an effect on noncompliance and may be considered for use in other medical settings.     

Reducing Parent Distress and Increasing Parent Coping-Promoting Behavior During Children's Medical Procedure

The study investigated whether involving parents in their child's cognitive-behavioral intervention would effectively reduce parent distress during their child's medical procedure. Parents participating with their 3- to 7-year-old children prior to a voiding cystourethrogram were randomly assigned to an intervention (N = 20) or a standard care (N = 20) condition. The intervention included provision of information, coping skills training, and parent coaching. Parents participating in the intervention had a significant reduction in anxiety following the intervention relative to parents in standard care. Trained parents displayed fewer distress-promoting and more coping-promoting behaviors during the procedure, even though parents in both conditions reported similar levels of anxiety during the procedure. Involving parents in children's interventions is crucial to reduce parent distress and prepare parents to assist their child during the medical procedure.     

Evaluating parent-implemented behavioral skills training for teaching firearm safety skills

Research shows that behavioral skills training (BST) and in situ training (IST) are effective interventions for teaching safety skills to children. In addition, the efficiency of these interventions can be increased when parents, teachers, or peers are taught to implement them. The purpose of this study was to replicate Novotny et al. (2020) and evaluate a web-based program for teaching parents to conduct BST to teach safety skills to prevent gunplay. We randomly assigned 18 children to the parent-conducted BST group or a control group and evaluated the intervention in a posttest only control group design. Children in the control group or treatment group who did not score a three in the in situ assessment (do not touch, get away, and tell an adult) received IST from their parents and were assessed again. Results showed that safety skill scores were statistically significantly higher in the treatment group than in the control group. Furthermore, there was a statistically significant increase in safety skills scores following IST for children who received it.     

Effects of decreasing intersession interval duration on graduated exposure treatment during simulated routine dental care

Reports suggest that individuals with developmental disabilities often engage in behavior during dental visits that precludes regular dental care. Graduated exposure therapies are an effective treatment for avoidant behavior in people with developmental delays, and some studies show that the duration of the intersession interval (ISI) can impact the effectiveness of graduated exposure treatments for typically developing individuals. The current study examined the effects of decreasing ISI on outcomes of a graduated exposure treatment during simulated routine dental care for 3 individuals diagnosed with autism. Treatment consisted of graduated exposure and extinction for disruptive behavior. Initially, sessions were conducted once per week. In subsequent conditions, treatment sessions were conducted 3‐5 times per week. A nonconcurrent multiple baseline across subjects design was used to demonstrate experimental control. Results suggest that decreasing ISI durations can produce improved treatment outcomes.     

PROMOTING PARENT-PROVIDER INTERACTION DURING YOUNG CHILDREN'S HEALTH-SUPERVISION VISITS

We prompted parents to increase their interactions with health-care providers during their children's health-supervision visits. Before scheduled appointments we asked parents of 32 infants and young children if they had specific child health questions or concerns. Sixteen parents randomly assigned to the prompted group were then prompted to initiate discussions of their concerns. Sixteen control parents discussed unrelated topics before their appointments. Prompted parents initiated significantly more interactions with health-care providers and more health and behavioral topics were discussed during their appointments. Both parent groups reported satisfaction with health-care services. Further research is needed to determine the clinical significance of outcomes associated with enhanced parent-provider interaction during children's health-supervision visits. These visits are ideal settings for behavioral research on improving health care for children and their families.     

Exposure-based treatment to control excessive blood glucose monitoring.

We investigated an exposure‐based procedure for reducing excessive checking of blood glucose by a child with diabetes. In a changing criterion design, an exposure‐based procedure was implemented by systematically exposing the child to decreasing amounts of information about blood sugar levels (checking) and thereby increasing exposure to potential hypoglycemia. Access to information was reduced in graduated increments, with the parents setting criteria to levels at which they were willing to adhere. Results demonstrated that the procedure was effective in reducing excessive blood glucose checking and in improving metabolic control.     

Evaluation of content and vocal style in relaxation instructions

The relative contributions of content and vocal style in relaxation instructions were studied in vivo. Eighty adult dental patients, 40 males and 40 females, who required two amalgam dental restorations were randomly assigned to four conditions (10 males and 10 females in each): a control group in which the restorations were completed in the typical fashion; a group who listened to standard relaxation instructions during the dental procedure; a group who listened to relaxation instructions presented in a conversational tone and pace: and a group who listened to a travelogue presented in a calm, quiet voice at a slow pace. Several cognitive self-rating measures and electrodermal response measures were obtained. The pattern of results suggested that content may be somewhat more important than style in relaxation instructions. However, both appear to be necessary to produce effective relaxation.     

Randomized Controlled Trial of Cognitive–Behavioral Group Therapy for Irritable Bowel Syndrome in a Medical Setting

Standard medical treatments have not been effective for irritable bowel syndrome (IBS) patients. Though individualized cognitive–behavior therapy is an empirically supported treatment option, cognitive–behavioral group therapy (CBGT) has yet to be established as an effective alternative in a randomized controlled trial. This study compared the efficacy of a 10-session CBGT with a home-based symptom monitoring with weekly telephone contact (SMTC) treatment for IBS, extending previous quasi-experimental research in this area. Twenty-eight refractory IBS patients, evaluated and referred by gastroenterologists using the Rome criteria, participated in the study. IBS symptoms, psychological functioning, and health-related quality of life were assessed pre- and posttreatment, and at 3-month follow-up. CBGT patients reported significantly more gastrointestinal (GI) symptom improvement than SMTC patients on posttreatment global measures and had significantly reduced daily diary pain scores at 3-month follow-up. Based on MANOVA, there was significant improvement in psychological distress and health-related quality of life for the CBGT patients in comparison to the SMTC patients. These improvements were also maintained at the 3-month follow-up. Reductions in GI symptoms, psychological distress, and improved health related quality of life may contribute to less behavioral avoidance, disability, and health care utilization in refractory IBS patients.     

THE GOOD TOOTHBRUSHING GAME: A SCHOOL-BASED DENTAL HYGIENE PROGRAM FOR INCREASING THE TOOTHBRUSHING EFFECTIVENESS OF CHILDREN

There has been a serious lack of experimentally verified, effective dental hygiene programs in the schools. In and of themselves, the instruction-alone programs which comprise children's dental education do not produce proper toothbrushing skills. In the present study, a school-based contingency dental hygiene program designed to increase the effectiveness of children's toothbrushing skills at home was implemented with grade one and two classes. Each class was divided into teams and participated in the “Good Toothbrushing Game.” Each day four children from each team had the cleanliness of their teeth assessed according to the Simplified Oral Hygiene Index (Greene & Vermillion, 1964). The team with the lowest mean oral hygiene score was declared the daily winner. Winning teams received stickers and had their names posted. A multiple baseline across classrooms single-subject group design (Hersen & Barlow, 1976, pp. 228–229) established that the good toothbrushing game greatly increased the effectiveness of children's oral hygiene skills. The treatment terminal level for the grade one scores was 2.0 as compared to a baseline terminal level of 5.0, and for the grade two's was 2.3 compared to 5.7 at the end of baseline. A 9-mo follow-up indicated that these results were maintained. The data strongly suggest that proper implementation of behavioral principles is essential to the success of oral hygiene programs.     

A meta-analysis of bibliotherapy studies

Used meta-analysis to examine the efficacy of bibliotherapy. Bibliotherapy treatments were compared to control groups and therapist-administered treatments. The mean estimated effect size (d) of the 70 samples analyzed was +0.565. There was no significant differences between the effects of bibliotherapy and therapist-administered treatments, as well as no significant erosion of effect sizes at follow-up. Bibliotherapy did appear more effective for certain problem types (assertion training, anxiety, and sexual dysfunction) than for others (weight loss, impulse control, and studying problems). Overall, the amount of therapist contact during bibliotherapy did not seem to relate to effectiveness, but there was evidence that certain problem types (weight loss and anxiety reduction) responded better with increased therapist contact. Recommendations for future research were given, especially for more research on the commonly purchased books and moderator analyses by personality type and reading ability. This article is based on a doctoral dissertation by Rick W. Marrs under the direction of Steven D. Brown at Loyola University of Chicago. I gratefully acknowledge the assistance of Dr. Brown as well as of my other committee members, Joseph Durlak and Gloria Lewis. I also gratefully acknowledge the assistance in coding done by Laura Marrs and John Gibson and helpful editorial comments made by Wayne Lucht.     

Distraction,Control, and Dental Stress1

This study examined the efficacy of external distraction as a coping strategy. Thirty-eight dental patients were randomly assigned to one of three groups: incidental music during the dental procedure, music coupled with suggestions that music would help reduce stress, or a no-treatment control group. Patients in both music groups reported experiencing less stress (i.e., less pain. less discomfort, more control) than patients in the no-treatment group. Patient ratings made by dentists, blind to condition, provided converging evidence for the therapeutic effect of distraction. Thus, distracting music was found to be effective in reducing stress and increasing perceptions of control. The relative ease and simplicity of implementing external distraction compared to manipulating actual control in a medical setting may make this manipulation attractive to professionals involved with individuals experiencing stress.     

Strengthening parent well‐being at the work—family interface: A German trial on workplace Triple P

This study examines the efficacy of a parenting training (Workplace Triple P (WPTP)) especially designed for the needs of employed parents. The program aims to reduce stress at the work–parenting interface by targeting family risk and protective factors and assisting parents to manage competing work and family demands. Ninety‐seven part‐ and full‐time working parents (74 mothers and 23 fathers; intervention group: n = 42 parents; waitlist‐control group n = 55 parents) from multiple organizations and multiple occupations with children between 2 and 10 years were randomly assigned to an intervention and a waitlist‐control condition. After the training, parents from the intervention condition, compared to those from the waitlist‐control condition, reported a significant reduction in individual and work‐related stress. Additionally, they reported a significant reduction in dysfunctional parenting and significant higher levels of parental and occupational self‐efficacy. Within the intervention condition all effects were maintained at the 3‐ and 6‐month follow‐up examinations. The findings support the notion that WPTP promotes parental well‐being and reduces stress at the work–parenting interface. Given that strengthening parenting skills has the potential to strengthen work, strategies to implement WPTP in organizational resources and community‐based services are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Enhancing Initial Parental Engagement in Interventions for Parents of Young Children: A Systematic Review of Experimental Studies

Low rates of participation in parenting interventions may undermine their effectiveness. Although a wide range of strategies to engage parents in interventions are described in the literature, little is known about which engagement strategies are most effective in enhancing parental engagement. This systematic review explores effective engagement strategies to encourage initial parental engagement (recruitment, enrolment, and first attendance) in parenting interventions for parents of children aged 2–8 years old. This review was conducted based on the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions (Higgins and Green 2011) and the Preferred Reporting Items for Systematic Review and Meta-Analysis (Moher et al. 2009). Electronic systematic searches from January 1996 to August 2017 were conducted in PsycINFO, Scopus, ProQuest Social Sciences Journals, CINAHL, and PubMed databases. Eight studies met the inclusion criteria representing 1952 parents from four different countries. Of the engagement strategies tested in included studies (monetary incentive, setting, testimonial, advertisement, and engagement package), three strategies (advertisement, incentive, and engagement package) showed a significant effect on a stage of engagement, but none across stages. The low methodological quality of the selected studies limits their generalisability and thus provides limited evidence regarding effective engagement strategies to increase recruitment, enrolment, and first attendance rates in parenting interventions. There is a need for further, more methodologically rigorous, research evidence regarding how to engage parents more effectively in the early stages of parenting interventions.     

A randomized controlled comparison of guided self-help cognitive behavioral therapy and behavioral weight loss for binge eating disorder

We performed a randomized controlled study to test the relative efficacy of guided self-help (gsh) cognitive-behavioral therapy (CBTgsh) and behavioral weight loss treatment (BWLgsh) treatments for binge eating disorder (BED). To provide an additional partial control for non-specific influences of attention, a third control (CON) treatment condition was included. We tested the treatments using a guided self-help approach given the promising results from initial studies using minimal therapist guidance. Ninety consecutive overweight patients (19 males, 71 females) with BED were randomly assigned (5:5:2 ratio) to one of three treatments: CBTgsh (N=37), BWLgsh (N=38), or CON (N=15). The three 12-week treatment conditions were administered individually following guided self-help protocols. Overall, 70 (78%) completed treatments; CBTgsh (87%) and CON (87%) had significantly higher completion rates than BWLgsh (67%). Intent-to-treat analyses revealed that CBTgsh had significantly higher remission rates (46%) than either BWLgsh (18%) or CON (13%). Weight loss was minimal and differed little across treatments. The findings suggest that CBT, administered via guided self-help, demonstrates efficacy for BED, but not for obesity. The findings support CBT administered via guided self-help as a first step in the treatment of BED and provide evidence for its specific effects.     

Dental anxiety,oral health‐related quality of life,and general well‐being: A self‐determination theory perspective

The aim of this study was to test a structural equation model (SEM) with the following hypotheses: (1) patients’ perceptions of oral health care professionals’ (i.e., dentists and dental hygienists) controlling interpersonal styles would positively predict patients’ dental anxiety through their basic psychological need frustration in treatment; (2) in turn, high dental anxiety would positively predict dysregulation of dental anxiety, which through a feedback loop contributes to perception of oral health care professionals’ controlling styles; and, (3) in addition, both dental anxiety and dysregulation of dental anxiety would predict poor Oral Health‐Related Quality of Life (OHRQoL) and subsequently poor general well‐being. A cross‐sectional study was conducted among 322 students at the University of Oslo. Participants responded to a survey with validated questionnaires. All variables in the model tested were acceptably normally distributed. The SEM did fit the data well and all hypotheses were supported. A bootstrapping procedure indicated that all indirect links in the model were supported. Analysis indicated that common method variance (CMV) did not seriously distort the results in this setting. Although the majority of oral health care professionals are perceived as being noncontrolling by their patients (51%), the proportion perceived as moderately (38%) or highly (11%) controlling represent a challenge for oral health care education and practice. It would be useful for oral health care professionals to be trained in avoiding a controlling treatment style.     

School-Based Mental Health Services: A Research Review

This paper provides a synthetic review of research on school-based mental health services. Schools play an increasingly important role in providing mental health services to children, yet most school-based programs being provided have no evidence to support their impact. A computerized search of references published between 1985 and 1999 was used to identify studies of school-based mental health services for children. Study inclusion was determined by (i) use of randomized, quasi-experimental, or multiple baseline research design; (ii) inclusion of a control group; (iii) use of standardized outcome measures; and (iv) baseline and postintervention outcome assessment. The application of these criteria yielded a final sample of 47 studies on which this review is based. Results suggest that there are a strong group of school-based mental health programs that have evidence of impact across a range of emotional and behavioral problems. However, there were no programs that specifically targeted particular clinical syndromes. Important features of the implementation process that increase the probability of service sustainability and maintenance were identified. These include (i) consistent program implementation; (ii) inclusion of parents, teachers, or peers; (iii) use of multiple modalities; (iv) integration of program content into general classroom curriculum; and (v) developmentally appropriate program components. Implications of these findings and directions for future research are discussed.