Reaching Latino Families Through Pediatric Primary Care: Outcomes of the CANNE Parent Training Program

The lack of culturally adapted parenting programs for Latinos contributes to low engagement in effective parenting programs. Criando a Nuestros Niños Hacio el Éxito (CANNE), a culturally adapted program, improves family dynamics by decreasing problematic child behavior and helping parents manage stress. CANNE was delivered with 12 Latino parents of children (age 3–7). Increased attendance and participation resulted in less child behavior problems and parenting stress from preintervention to postintervention. A culturally relevant adaptation of an evidence-based parenting program improved engagement, child behavioral outcomes, and parenting stress. Implications of mental health services in primary care facilities for Latino families are addressed.     

Counseling Chemically Dependent Chronic Pain Patients in an Integrated Care Setting

This article identifies the chronic pain population and explores a holistic integrated approach to treatment and its appropriateness for counseling the chronic pain patient with substance use disorders.     

Maternal Depression and Parent Management Training Outcomes

This study examines the impact of maternal depression on reductions in children’s behavior problems severity following implementation of the Brief Behavioral Intervention—a brief, manualized parent management training treatment. The parents of 87 children aged 2–6 years of age received parent management training at a metropolitan hospital. Parents of participants completed measures of externalizing behavior and maternal depression. The association between pre-post treatment change in externalizing behavior and maternal depression was examined using an autoregressive cross-lagged model. Results showed that self-reported maternal depressive symptoms at pre-treatment negatively influenced the overall magnitude of reduction of reported externalizing behaviors in children following treatment. Results indicate that aspects of family functioning not specifically targeted by parent management training, such as maternal depression, significantly affect treatment outcomes. Clinicians providing parent management training may benefit from assessing for maternal depression and modifying treatment as indicated.     

Impact of Child and Parent Motivation on Social Skills Training Outcome

This study explores child and parent motivation at the start of a social skills training group program and its relationship with treatment outcome. A total of 59 children (aged 7–12) participated. Parents were more aware of, distressed by, and motivated to change the presenting problem than were their children. Greater parent awareness of their child’s difficulty making and keeping friends and perceived importance of their child learning ways to make and keep more friends significantly predicted more improved social skills. Increasing parents’ awareness and perceived importance of treating the presenting problem at the start of therapy may increase treatment effectiveness.     

Predictors and Correlates of Completing Behavioral Parent Training for the Treatment of Oppositional Defiant Disorder in Pediatric Primary Care

This study examined the role of pretreatment demographic and clinical predictors of attendance as well as barriers to treatment and consumer satisfaction on attendance at therapist-led parent training with 86 families of children ages 3 to 6 years conducted in pediatric primary care settings. Only socioeconomic status (SES) and minority group membership were significantly associated with not completing treatment. Using optimal data analysis procedures, high SES correctly predicted treatment completion 83.6% of the time. Being from a low SES, minority group family correctly predicted noncompletion of treatment 72.7% of the time, but being from a low SES, white family predicted treatment completion 80% of the time. Since barriers to treatment, such as stressors, obstacles to treatment, and treatment demands were unrelated to attendance in the present study, other factors related to social class and minority status that could contribute to better consumer satisfaction and treatment attendance must be investigated.     

Training and Maintaining System-Wide Reliability in Outcome Management

The Child and Adolescent Functional Assessment Scale (CAFAS) is widely used for outcome management, for providing real time client and program level data, and the monitoring of evidence-based practices. Methods of reliability training and the assessment of rater drift are critical for service decision-making within organizations and systems of care. We assessed two approaches for CAFAS training: external technical assistance and internal technical assistance. To this end, we sampled 315 practitioners trained by external technical assistance approach from 2,344 Ontario practitioners who had achieved reliability on the CAFAS. To assess the internal technical assistance approach as a reliable alternative training method, 140 practitioners trained internally were selected from the same pool of certified raters. Reliabilities were high for both practitioners trained by external technical assistance and internal technical assistance approaches (.909–.995, .915–.997, respectively). 1 and 3-year estimates showed some drift on several scales. High and consistent reliabilities over time and training method has implications for CAFAS training of behavioral health care practitioners, and the maintenance of CAFAS as a global outcome management tool in systems of care.     

Implementing Parent Management Training in the Context of Poverty

Parent management training (PMT) is a well-investigated, effective, and preferred treatment for children's externalizing behaviors and related disorders. Unfortunately, PMT is not as effective for children living in poor families, who disproportionately exhibit the behaviors that PMT is designed to correct. We suggest that PMT is less successful for poor children because (1) the same factors that explain the relation between economic hardship and children's externalizing behaviors also are related to unsuccessful PMT outcomes; and (2) PMT interventions are less acceptable to poor parents, and therefore less likely to be adopted. Clinical implications are drawn from the analysis.

     

Pain Assessment and Management in the Long-Term Care Setting

The assessment and management of pain is a significant public health problem in the United States. Long-term care facilities face unique barriers and challenges to pain management due to the large population of cognitively impaired residents, little physician contact and poor pain education for nurses and nurse assistants. In addition, common misconceptions about pain and pain treatment in the elderly along with health professional and resident fears of addiction and drug toxicity, add to the problem of pain management. The basic principles of pain treatment in long-term care are identical to all other health care settings – utilizing a combination of drug and non-drug treatments. Recent efforts to institutionalize improved pain management practices, through assessment procedures and defined pain management policies, standards and education programming, is a promising venue for systemically improving pain treatment in long-term care settings.     

Interprofessional Education: Preparing Psychologists for Success in Integrated Primary Care

Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another’s disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings.     

Parent and Primary Care Provider Priorities for Wellness in Early Childhood: A Discrete Choice Experiment

Journal of Child and Family Studies - Guidelines recommend that primary care clinicians address a broad range of wellness topics, but time constraints limit clinicians’ ability to address...     

Primary Care Provider Familiarity with Binge Eating Disorder and Implications for Obesity Management: A Preliminary Survey

Current guidelines for the evaluation and treatment of obesity recommend referring individuals with binge eating disorder (BED) to a mental health professional. However, it is unclear how familiar primary care providers are with BED. The purpose of this study was to assess providers' familiarity with BED diagnosis and treatment. Providers in two primary care clinics completed a questionnaire, which assessed perceived familiarity with BED and demonstrated familiarity with BED diagnosis and treatment. Results indicated that 61% of respondents demonstrated familiarity with the essential symptoms of BED, and 80% reported familiarity with the diagnosis of BED. However, 35% of respondents who perceived themselves as familiar with BED did not demonstrate familiarity with the most basic symptoms. These results demonstrate that while many providers in primary care are familiar with BED, steps to improve provider familiarity with the disorder and provide appropriate mechanisms to address BED are warranted.     

Medical Family Therapy in a Primary Care Setting: A Framework for Integration

As the profession of marriage and family therapy (MFT), as well as the emerging sub-specialty of medical family therapy (MedFT), continue to grow and evolve within the current healthcare system, the arena of integrated primary care (IPC) presents an ideal environment for professionals who are relationally and systemically inclined. Although there has been a inundation of literature detailing collaborative systems of healthcare, several gaps still exist: (a) a lack of horizontally integrated models (i.e., models that do not target specific diseases or demographic populations), (b) a lack of model utilization regardless of disease trajectory (i.e., decline, stabilization, improvement), and (c) a lack of IPC models explicitly utilizing MedFT/MFTs as the mental health providers within the system. In lieu of these gaps, the authors present a framework for IPC, utilizing MedFTs/MFTs, that is neither population nor disease specific, as well as a model geared towards implementation regardless of disease trajectory. The framework, which was obtained using ethnography of communication, details MedFTs?? interactions with front line medical providers and patients from initial contact through coordination of a shared treatment plan. Recommendations for future research studies incorporating the use of MedFTs in integrated primary care settings are extended in the context of a three world view framework (Peek in Collaborative medicine case studies: Evidence in practice. Springer, New York, pp 25?C38, 2008; Peek and Heinrich in Family Syst Med 13:327?C342, 1995, Integrated primary care: the future of medical and mental health collaboration. Norton, New York, pp 167?C202, 1998).     

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

Parenting Cognition and Affective Outcomes Following Parent Management Training: A Systematic Review

Parent management training (PMT) is considered the gold standard in the treatment of child behavior problems. The secondary effects of these interventions, particularly on parent well-being, are infrequently studied, despite evidence that parents of children with behavior problems often experience personal difficulties. This narrative review examined the affective and parenting cognition outcomes of PMT for mothers and fathers of children ages 2–13 years, across 48 controlled treatment studies. Substantial support was found for reductions in parenting stress, and increases in perceived parenting competence following PMT. Evidence indicated fewer improvements in domains more distal from parenting, including parent depressive symptoms and marital relationship dysfunction. A number of studies suggested parent gender as a moderator of parent outcomes of PMT; however, the underrepresentation of fathers in existing research limits conclusions in this regard. Avenues for future research are highlighted to address current gaps in the literature, and to further our understanding of the ways in which both children and parents may benefit from PMT.