Feasibility and acceptability of a brief suicide intervention for youth involved with the family court

As efforts to develop models for suicide prevention and intervention in the juvenile justice (JJ) system continue to grow, research to understand the feasibility and acceptability of implementing these models is critical. Examining organizational readiness for implementation, ensuring leadership and staff buy‐in for delivering the intervention, and planning for sustainability of staff participation in implementation efforts is essential. The current study involved semi‐structured formative evaluation interviews with key JJ stakeholders (n = 10) to determine perspectives on the acceptability (perceived need and fit of the intervention) and feasibility (organizational readiness for change) of a proposed brief safety planning intervention for youth with suicidal ideation delivered by nonclinical staff and integrated into the existing system. Qualitative data revealed stakeholders' perceived need for the intervention in the family court context and their agreement that the aims of the intervention were congruent with the goals of the family court. Some barriers to successful implementation were noted, which, addressed through selection of appropriate implementation strategies, can be overcome in a future test of the safety intervention.     

Evaluation of a Family Systems Intervention for Managing Pediatric Chronic Illness: Mastering Each New Direction (MEND)

Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness.     

Effectiveness of Cognitive/Behavioral Small Group Intervention for Reduction of Depression and Stress in Non-Hispanic White and Hispanic/Latino Women Dementia Family Caregivers: Outcomes and Mediators of Change

This study enrolled 184 middle-aged and older women (95 Non-Hispanic White and 89 Hispanic/Latino) who provided in-home hands-on care to an elderly relative with Alzheimer’s disease or another form of dementia. Within ethnic group they were randomly assigned to either a CBT-based small group intervention program called “Coping with Caregiving” (CWC) that taught a variety of cognitive and behavioral skills to reduce stress and depression, or to a minimal telephone based control condition (TSC). Intervention lasted about 4 months; one post-treatment assessment was completed 6 months after baseline by interviewers blind to the intervention condition. Interviews and interventions were conducted in English or Spanish by trained staff. Results indicated that those in the CWC (regardless of ethnicity) showed greater improvement from pre to post intervention than those in the TSC on measures of depressive symptoms, overall life stress, and caregiving-specific stress. In order to investigate if these changes may have been related to one proposed mechanism of change in CBT (skill utilization), a new measure was constructed. Change in frequency of use and perceived helpfulness of adaptive coping skills were assessed in all caregivers. Results indicated that caregivers in CWC reported greater frequency of use, and greater perceived helpfulness, of these skills at post intervention compared to caregivers in the TSC. Improvement measured by dependent measures was correlated with an increase in these indices for those in the CWC. Tests for mediation suggest that effective skill utilization may mediate the effect of treatment on outcome. Implications of these findings are discussed and recommendations provided for future research.     

An ecological framework for understanding risk for exposure to community violence and the effects of exposure on children and adolescents

This review covers the past decade's research on the risk for exposure to community violence and the effects of exposure on children's and adolescents' functioning. The studies are incorporated into a developmental-ecological framework that takes into account five domains of context—community and neighborhood, family and household, relationships with parents and caregivers, relationships with peers, and personal characteristics—for the purpose of identifying the risks for exposure and its effects on outcome and for suggesting the processes involved. Evidence from the literature is consistent with our proposed ecological model showing that variables in each of the five domains have both direct and indirect effects on risk for exposure and on its effects on internalizing and externalizing problems and academic functioning. Implications of adopting an ecological model for future risk research and for prevention and intervention are considered.     

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.     

A socioemotional intervention in a Latin American orphanage

A pilot intervention that emphasized training and technical assistance to promote warm, sensitive, and responsive one‐on‐one caregiver–child interactions primarily during feeding and bathing/changing was implemented using regular staff in a depressed orphanage for children birth to approximately 8 years of age in Latin America. Despite a variety of unanticipated irregularities in the implementation of the intervention, many beyond the researchers' control, ward environments improved; caregivers displayed more warm, sensitive, and responsive interactions with children; and children improved an average of 13.5 developmental quotient (DQ) points after 4+ months' exposure to the completed intervention. Furthermore, 82% of the children had DQs greater than 70 before the intervention, but only 27.8% did so afterward. Although the training for all caregivers was aimed at children birth to 3 years, the number of different caregivers was reduced, and technical assistance was provided only to caregivers serving children less than 3 years, younger and older children (3–8 years) improved approximately the same amount. However, children who were transitioned from a younger to an older ward during the intervention improved less than did children who remained in either a younger or an older ward, the first evidence suggesting that the common orphanage practice of periodically graduating children from one homogeneous age group to another may impede their development. The study is consistent with others that have shown that orphanages can be changed, and increases primarily in warm, sensitive, responsive caregiver–child interactions can produce improvements in children's development.     

Parenting of low birth weight infants: A review of issues and interventions

Factors that may adversely affect parenting of low birth weight infants, including infant characteristics, parental emotional responses to premature birth, and patterns of parent-infant interaction, are reviewed. In addition, intervention studies designed to improve infant developmental outcomes through influencing parenting behaviors are examined. There was great diversity in theoretical frameworks, in timing of onset and frequency of interventions, and in measurement of outcomes. The interventions that were most effective in influencing behaviors and infant developmental outcomes were those in which there were multiple long-term contacts with parents and/or those that actively involved them in the intervention. The specific theoretical framework upon which the interventions were based appeared to be of less importance in influencing results. In order to increase our knowledge and ability to provide costeffective programs, there is a need to focus attention and data collection efforts on the process and intermediary steps of intervention as well as on outcome measures. There is also a need to improve our ability to recruit and retain those families who are most at risk for parenting and infant developmental problems including those with very low birth weight infants, those whose infants have serious perinatal complications, and those with indications of high social risk such as poverty-level incomes and problems of substance abuse.     

Child and Caregiver Dropout in Child Psychotherapy for Trauma

This study focused on the identification of variables collected at baseline assessments that predict children and caregivers who are at risk for dropout from treatment. A sample of 115 children and their caregivers who received evidence-based treatment for traumatic stress was utilized for this study. Multinomial logistic regression analyses indicated that caregiver and child age, the child's externalizing behaviors, and the child and caregiver's acknowledgment of posttraumatic stress symptoms significantly predicted premature dropout from treatment. Clarification of child and caregiver characteristics that increase the risk of dropout allows for the identification of families in need of additional support to stay in treatment.     

Feasibility of Undertaking Off‐Site Infant Eye‐Tracking Assessments of Neuro‐Cognitive Functioning in Early‐Intervention Centres

Recent work suggests that differences in functional brain development are already identifiable in 6‐ to 9‐month‐old infants from low socio‐economic status (SES) backgrounds. Investigation of early SES‐related differences in neuro‐cognitive functioning requires the recruitment of large and diverse samples of infants, yet it is often difficult to persuade low‐SES parents to come to a university setting. One solution is to recruit infants through early intervention children's centres (CCs). These are often located in areas of high relative deprivation to support young children. Given the increasing portability of eye‐tracking equipment, assessment of large clusters of infants could be undertaken in centres by suitably trained early intervention staff. Here, we report on a study involving 174 infants and their parents, carried out in partnership with CCs, exploring the feasibility of this approach. We report the processes of setting up the project and participant recruitment. We report the diversity of sample obtained on the engagement of CC staff in training and the process of assessment itself. We report the quality of the data obtained, and the levels of engagement of parents and infants. We conclude that this approach has great potential for recruiting large and diverse samples worldwide, provides sufficiently reliable data and is engaging to staff, parents and infants. Copyright © 2015 John Wiley & Sons, Ltd.     

Feasibility and impact of a school-based intervention for families of urban adolescents with asthma: results from a randomized pilot trial

The purpose of this study was to test the feasibility and short-term outcomes of Asthma: It's a Family Affair!, a school-based intervention for adolescents with asthma and their caregivers. Twenty-four ethnic minority families with a middle school student with asthma were randomized to immediate intervention or no-treatment control. Intervention students received six group sessions on prevention and management of asthma. Caregivers received five group sessions teaching child-rearing skills to support the youth's autonomy and asthma self-management. All students attended all sessions; caregivers attended an average of three. Two months post-intervention, relative to controls, intervention caregivers reported better problem-solving with children. Intervention students were more responsible for carrying medication, took more prevention steps, and woke fewer nights from asthma. The intervention resulted in positive short-term changes in family relations, asthma management by students, and health status.     

Interest in and barriers to participation in multiple family groups among head and neck cancer survivors and their primary family caregivers

This study examined interest in and barriers to participation in a multiple family group intervention (MFG) for adult cancer survivors and their family caregivers. The intervention was developed to assist families in coping with the persistent challenges of cancer diagnosis, treatment, and rehabilitation. Eighty eligible families having a member diagnosed and treated for cancers of the head and neck region completed a baseline quality of life survey consisting of standardized psychosocial measures, and then all patients and their families were invited to participate in a day-long multiple family group program. However, despite extensive recruitment efforts and accommodations to address anticipated barriers for nonparticipation, only 15 of the 80 (19%) eligible families agreed to attend the MFG workshop. Post-MFG, participating families reported high levels of program satisfaction and usefulness. These findings are discussed in the context of increasing the use of family-focused interventions in cancer care settings.     

Teaching complex verbal operants to children with autism and establishing generalization using the peak curriculum

The present study evaluated the feasibility of the PEAK Relational Training System's Generalization Module (Dixon, 2014b) to teach and establish generalization of autoclitic mands, distorted tacts, and creative path finding in three children diagnosed with autism spectrum disorder. Using a multiple‐baseline design across behaviors, each participant was provided with differential reinforcement and a least‐to‐most prompting hierarchy for correct responses to a subset of stimuli, and responses to other similar stimulus sets were probed for emergent generalization. Following training, each participant successfully acquired the directly trained behaviors and demonstrated generalization to the nonreinforced test exemplars. These data support the utility of Skinner's (1957) analysis to teach complex forms of verbal operants, and suggest that a manualized curriculum such as PEAK may have utility for promoting skill development and generalization for front line staff and caregivers of children with autism.     

Adapting the Unique Minds Program: Exploring the Feasibility of a Multiple Family Intervention for Children with Learning Disabilities in the Context of Spain

The Unique Minds Program (Stern, Unique Minds Program, 1999) addresses the socio‐emotional needs of children with learning disabilities (LD) and their families. Children and their parents work together in a multiple family group to learn more about LD and themselves as people with the capacity to solve problems in a collaborative way, including problems in family school relationships. This article reports the cultural adaptation of the program for use in Spain and findings from a feasibility study involving three multiple family groups and a total of 15 children and 15 mothers, using a pre‐post design. This Spanish adaptation of the program is called “Mentes Únicas”. Standardized outcome measures indicated an overall statistically significant decrease in children's self‐rated maladjustment and relationship difficulties by the end of the program. Improvements were endorsed by most mothers, although they were not always recognized by the children's teachers. The program had a high level of acceptability: Mothers and children felt safe, understood, and helped throughout the sessions. The efficacy of the adapted intervention for the context of Spain remains to be tested in a more rigorous study.     

Aggressive encounters between patients and general hospital staff: Staff perceptions of the context and assailants' levels of cognitive processing

A considerable body of research has accumulated regarding aggression toward health care staff, yet little is known about the contextual factors involved. The present study examined the context within which aggressive incidents occurred and the dynamics of the interaction between staff and patients. Two aspects in particular were investigated; firstly, whether incidents were preceded by some anxiety provoking stimulus and secondly, the assailants' levels of cognitive processing apparent at the time of the incident. A prospective study collected data concerning incidents of physical assault and threatening behaviour in a general hospital. Staff were interviewed soon after the incident occurred. A content analysis determined that 82.8% of incidents involved experiences delivered by the staff victims likely to have provoked anxiety in the assailant. Most commonly, incidents involved staff intervening in the patient's intended behaviour. In addition, in 64% of cases, assailants were actually displaying some impairment in cognitive processing at the time of the incident Data suggest that many patients may not have been fully aware of their situation and might have experienced some difficulty in comprehending the staff member's actions. Patients who do not appear to understand what is happening may require additional time and effort to ensure they comprehend fully and accept what the staff member is intending to do, particularly if patients are experiencing an event likely to increase anxiety levels. Aggr. Behav. 30:534–543, 2004. © 2004 Wiley‐Liss, Inc.     

Case study: Examining the relationship between self-initiations of an individual with disabilities and directive behavior of staff persons in a residential setting

This case study examines the relationship between self-initiations of an adult woman with severe disabilities and the directive behavior of staff persons in a community residential setting. Hypotheses generated from functional assessment procedures indicated that (a) Susan's low self-initiations were very likely related to high directive behavior of staff persons, and (b) infrequent problem behaviors during the morning routine were maintained by escape from repeated staff demands. An intervention was implemented to enable Susan to increase self-initiation in choice and sequence of activities and simultaneously decrease staff directives. Results and discussion focus on the need for a contextual approach for addressing problematic situations and an affirmation of the effectiveness of the positive behavioral support technology for increasing adaptive behaviors in individuals with severe disabilities.     

Emotional interactions and an ethics of care: Caring relations in families affected by HIV and AIDS

In the context of global processes of economic restructuring, the HIV and AIDS epidemic and socio-cultural constructions of care, many women and young people in low-income households have been drawn into caring roles within the family. Drawing on the literature on an ethics of care, emotional geographies and embodiment, this paper examines the emotional dynamics of the caring process in families affected by HIV and AIDS. Based on the perspectives of both ‘caregivers’ and ‘care-receivers’ from research undertaken in Namibia, Tanzania and the UK, we examine the everyday practices of care that women and young people are engaged in and explore how emotions are performed and managed in caring relationships. Our research suggests caregivers play a crucial role in providing emotional support and reassurance to people with HIV, which in turn often affects caregivers' emotional and physical wellbeing. Within environments where emotional expression is restricted and HIV is heavily stigmatised, caregivers and care-receivers seek to regulate their emotions in order to protect family members from the emotional impacts of a chronic, life-limiting illness. However, whilst caregiving and receiving may lead to close emotional connections and a high level of responsiveness, the intensity of intimate caring relationships, isolation and lack of access to adequate resources can cause tensions and contradictory feelings that may be difficult to manage. These conflicts can severely constrain carers' ability to provide the ‘good care’ that integrates the key ethical phases in Tronto's (1993) ideal of the caring process.     

The Benefits and Limitations of a Behavioral Intervention for Caregivers of Dementia Patients: A Qualitative Study

This study used qualitative methods to understand dementia caregivers’ experience of personal and therapeutic factors contributing to outcome following REACH VA, a behavioral intervention designed to alleviate caregiver burden and depressive symptoms. Caregivers and their interventionists were queried about their experiences of the treatment in semistructured interviews. Interviews were transcribed and analyzed using thematic analysis. The following themes emerged reflecting aspects of the intervention caregivers and interventionists found helpful: self-care, shared goals, psychoeducation, and stress-management skills. Some caregivers and interventionists found the provision of problem-solving skills to be helpful and others did not. Finally, some caregivers and interventionists reported that interpersonal support/bearing witness, insight, emotional transformation, and the discussion of interpersonal process were useful when part of the intervention or, when not included, would have been helpful. While behavioral interventions tend to be highly structured, interventionists’ ability to work flexibly within the protocol and tailor it to the caregiver’s needs was related to positive treatment response. The beneficial aspects of this treatment represent multiple theoretical orientations highlighting the importance of transtheoretical models of therapeutic action.     

Outcomes of a Comparison Study into a Group-Based Infant Parenting Programme

This paper reports on a quantitative evaluation of a group-based programme designed to promote parent-infant attachment and child development. Whilst group-based parenting programmes are recommended for treating and preventing conduct disorder in older children, there is, as yet, little evidence as to whether they have a positive effect on very young children and their carers’. Recent UK Government initiatives to support families and improve parenting skills in the first 2 years of children’s lives have increased the demand for the delivery and evaluation of community-based programmes. Eighty mother–child dyads were recruited from nine areas to intervention (n = 54) and control condition (n = 26). Baseline measures were collected in the children’s home when the infants were on average 3-months-old, and follow-up measures were collected 6 months post-baseline (N = 63). Mothers’ positive play behaviours were independently coded from video recordings taken in the home. Other measures included self-reported maternal confidence and mental well-being, assessed infant development and home environment. Socio-demographic data was collected once at baseline. After controlling for baseline scores, control mothers were observed to be significantly less sensitive during play with their baby at the 6 months follow-up with a significant increase in confidence. No differences were found between the groups on the other measures. This paper provides limited evidence for the effectiveness of the Incredible Years Parents and Babies group-based programme delivered in the first year of life. Further evaluation, particularly with parents at increased risk of poorer outcomes is needed to confirm and extend these results.