Treatment Engagement: Building Therapeutic Alliance in Home-Based Treatment with Adolescents and their Families

Client engagement is an essential yet challenging ingredient in effective therapy. Engaged clients are more likely to bond with therapists and counselors, endorse treatment goals, participate to a greater degree, remain in treatment longer, and report higher levels of satisfaction. This study explored the process of engaging high-risk youth and their parents in a unique home-based family therapy intervention. Qualitative interviews were conducted with 19 families who completed family therapy sessions that included a core component aimed at increasing treatment engagement. Parents’ and youths’ perceptions of engagement suggest the importance of developing therapeutic alliance with therapists, who facilitated building a shared alliance among family members. Implications for improving client engagement are discussed within the context of alliance building with the therapist and among family members.     

Advances in the Conceptualization,Assessment, and Treatment of Pediatric Irritability

Pediatric irritability is a functionally impairing transdiagnostic symptom underlying a substantial proportion of child mental health referrals. The past 20 years have witnessed a striking uptick in empirical work focused on pediatric irritability, with increasing recognition of its role across multiple internalizing and externalizing disorders. That said, it has only been in recent years that research has begun to make advances in understanding the natural course and neurobiological underpinnings of irritability across development; research directly informing effective clinical management of pediatric irritability has been limited. At this critical stage in the study of pediatric irritability, this special series brings together the latest work from leading experts across three interrelated domains: (a) progress in understanding the phenomenology and course of pediatric irritability; (b) advances in the assessment of pediatric irritability; and (c) innovations in the treatment of pediatric irritability. The papers in this special series collectively offer critical steps forward for better understanding pediatric irritability and improving proper assessment, classification, and clinical management.     

Parental Social Cognitions: Considerations in the Acceptability of and Engagement in Behavioral Parent Training

Behavioral parent training (BPT) is a widely used, evidence-based treatment for externalizing child behaviors. However, the ability of BPT programs to be maximally effective remains limited by relatively low rates of acceptance, attendance, and adherence to treatment. Previous reviews have focused on a variety of demographic and mental health characteristics of parents and children that are predictive of poor outcomes in BPT. This paper focuses instead on consideration of parental social cognitions, and how incorporation of these cognitions may, or may not, be useful in advancing the effectiveness of BPT. We first review evidence suggesting limited incremental effects to incorporating parental cognitions within the context of BPT programs. Then, we examine the role of two particular types of parental social cognitions, attributions and parenting efficacy, in relation to the initial stages of accepting and engaging in BPT. We conclude by noting limitations in available research on the links between parental social cognitions and BPT, and we outline a number of potentially useful directions that may clarify whether or not parental social cognitions should be accorded greater attention either in the initial stages or throughout BPT programs.     

Engagement in Child and Adolescent Treatment: The Role of Parental Cognitions and Attributions

Parental engagement in the treatment process is influenced by parents' beliefs about the cause of their children's problems, perceptions about their ability to handle such problems, and expectations about the ability of therapy to help them. This paper examines the role of parental cognitions related to attributions and expectations in relation to engagement in child mental health treatment. Reviewed studies indicate that parental attributions and expectations influence three aspects of treatment: help seeking, engagement and retention, and outcome. This paper integrates findings from developmental and clinical research, highlights gaps in the literature, presents the beginnings of a model regarding the parental attributional process as it relates to engagement in treatment, recommends future research directions, and discusses clinical implications.     

Autogenic Feedback in the Treatment of Two Children with Migraine Headache

Autogenic feedback was used to treat two subjects, ages 12 to 14, suffering form migraine headache. A multiple baseline across subjects design was used to evaluate treatment outcome. Marked improvement was displayed on all three measures of headache activity for both subjects by the end of treatment and was maintained throughout the follow-up period. These results are comparable to those obtained when similar procedures are applied to chronic adult headache sufferers and suggest that continued investigation is warranted.     

Utilizing Family Strengths and Resilience: Integrative Family and Systems Treatment with Children and Adolescents with Severe Emotional and Behavioral Problems

Community mental health agencies are consistently challenged to provide realistic and effective home-based family-centered treatment that meets local needs and can realistically fit within available budget and resource capabilities. Integrated Family and Systems Treatment (I-FAST) is developed based on existing evidence-based approaches for working with at-risk children, adolescents, and families and a strengths perspective. I-FAST identified 3 evidence-based, core treatment components and integrated them into a coherent treatment protocol; this is done in a way that builds on and is integrated with mental health agencies' existing expertise in home-based treatment. This is an intervention development study in which we conducted an initial feasibility trial of I-FAST for treating families with children at risk of out-of-home placement. The outcomes of the study provide initial empirical evidence that supports the effectiveness of I-FAST. Findings indicate that there were significant improvements in child behavior, significant increases in parental competency, and significant increases in the level of cohesion and adaptability in these families. All observed changes were significant from pre- to posttreatment with the families able to maintain these positive changes at 6-month follow-up. A more rigorous and robust research design, however, will be needed to establish definitive evidence of the effectiveness of I-FAST.     

Linguistic Analysis of Written Narratives of Caregivers of Children and Adolescents with Chronic Illness: Cognitive and Emotional Processes and Physical and Psychological Health Outcomes

Used linguistic analysis of written narratives of caregivers of hospitalized youth with chronic illness to identify emotional and cognitive processes related to physical and psychological health outcomes following writing. Measures were administered at baseline and 4 months. Experimental group (n = 29) wrote about traumas whereas the control group (n = 24) wrote about summer activities for 20 min on three different days. Compared groups on negative emotion- and cognition-related word use. Tested change in negative emotion- and cognition-related word use as predictors of outcomes in experimental group. Consistent with hypotheses, experimental group used more negative emotion words [F(1, 53) = 77.55, p < .001] and cognition-related words than control group [F(1, 53) = 19.09, p < .001] and an increase in cognition words predicted Physical Health Summary Score on SF-36 (standardized = .37, p < .05). A decrease in negative emotion words was related to Physical Health Summary Score on SF-36 only when entered into regression with change in cognition words (standardized = –.31, p < .05). A decrease in negative emotion together with an increase in cognitive processing facilitated by written emotional disclosure has beneficial effects on physical health-related quality of life.     

Depressed and Anxious COPD Patients: Predictors of Psychotherapy Engagement from a Clinical Trial

This study examined patient-level factors associated with engagement in mental health treatment in a sample of medically ill patients with clinically significant symptoms of depression and/or anxiety. A total of 248 patients was enlisted from a randomized controlled trial of cognitive-behavioral therapy for depression and anxiety in patients with chronic obstructive pulmonary disease (COPD). Logistic regression analysis was used to predict mental health engagement, defined as attending at least one intervention session. Results indicated that patient-perceived mastery over COPD was negatively related to mental health engagement. Further, mastery was the only significant predictor of mental health engagement after controlling for patient demographic characteristics, severity of COPD, depression, and anxiety. To improve engagement for medically ill patients with comorbid mental health difficulties, clinicians should explore patients’ attitudes about their mental health within the context of their perceived ability to cope with their medical disease.     

Functional Impairment in Latino Children with ADHD: Implications for Culturally Appropriate Conceptualization and Measurement

Conceptualizing and measuring functional impairment related to childhood ADHD, particularly within the rapidly growing, yet underserved, Latino population, is an important area of research that is in its infancy in the field of psychology. The functional impairments related to academic achievement, social competence, and familial relations experienced by children with ADHD lead to long-lasting and debilitating difficulties that adversely affect the individuals themselves, their families, and society. In addition, limited available research suggests that Latino children are at a great or greater risk for developing ADHD, although they are much less likely to be identified by their parents as displaying problematic behavior and subsequently are less likely to receive proper assessment and treatment due to several practical and cultural factors. Fortunately, initial evidence suggests that the construct of functional impairment may be a more universal notion than the potentially culturally biased measurement of symptomatology. Therefore, in order to provide the best possible outcomes for all children with ADHD, research needs to be expanded to include examination of functional impairment related to ADHD, particularly when working with Latino children and their families. Thus, the primary aim of the current review is to examine and critique how the field of psychology has understood and measured functional impairment in school-aged Latino children with ADHD to date. Based on information reviewed, suggestions for moving toward a culturally modified assessment of functional impairment related to ADHD in Latino children will be proposed. This work is a necessary step toward providing culturally appropriate services for a currently underserved, yet rapidly growing, Latino population in our country.     

Family Unification with Reactive Attachment Disorder Children: A Brief Treatment

This is a case study of a family with a child (age eight) with reactive attachment disorder and the subsequent individual and family therapy. Treatment of choice for the child was Eye Movement Desensitization and Reprocessing (EMDR) and supportive educational counseling for the parents and family. Qualitative evaluation of the process demonstrated that the parents observed an instant change in the child's attitude. The child reported that she felt better about family, school, and truthfulness, and stated about the therapy: It opened a window for me. A 12-month evaluation demonstrated continued positive effects.     

Outcomes for Children and Adolescents After Residential Treatment: A Review of Research from 1993 to 2003

The focus of this research review is to determine what factors increase the likelihood that positive individual and systemic changes occur for children and adolescents following discharge from residential treatment. Residential treatment outcome studies from 1993 to 2003 that fulfilled predetermined criteria were located through 4 on-line databases using key word combinations. The research selected was: (a) 7 studies that measured outcome immediately upon completion of treatment and discharge, and (b) 11 studies where outcome progress was assessed at one or more follow-up dates after discharge. Results showed that children and adolescents with severe emotional and behaviour disorders can benefit and sustain positive outcomes from residential treatment that is multi-modal, holistic and ecological in its approach. Similar to the clinical child psychotherapy research, conclusions must be tempered due to the limited number of studies and methodological weaknesses. Future considerations highlight how research results can more realistically reflect intervention effectiveness when elements of the ecological and systemic landscape of care are addressed.     

Peer-Delivered Models for Caregivers of Children and Adults with Health Conditions: A Review

Peer-delivered health models may hold important benefits for family members, yet their prevalence, components, and outcomes are unknown. We conducted a review of peer-delivered services for families of children and adults with serious health problems. Studies of interventions published between 2000 and 2016 were included if the intervention contained a component for family members. Of 88 studies that were assessed for their eligibility, five met criteria. Familial components included information about the health condition and management, strategies to enhance communication and stress, and the provision of emotional support. Outcomes were largely favorable, including reductions in distress and symptoms of trauma, enhanced quality of life, and positive perceptions of the peer therapeutic alliance. Peer-delivered services for family members may hold important benefits to caregivers; however, the research base remains thin. A research agenda to develop and examine these models is discussed.     

The impact of brief teacher training on classroom management and child behavior in at-risk preschool settings: Mediators and treatment utility

Teachers from fourteen classrooms were randomly assigned to an adaptation of Incredible Years (IY) teacher training or to teacher training-as-usual. Observations were made of the behavior of 136 target preschool boys and girls nominated by teachers as having many or few conduct problems. Peer and teacher behavior were observed at baseline and post training. IY training resulted in increases in teachers' positive and reductions in teachers' negative behavior relative to training as usual, in decreased peer negative behavior toward target children, and in decreased negative behavior of target children high on conduct problems. The impact of IY training on the behavior of target children was mediated by changes in peers' behavior with no direct effects of teacher behavior and differential effects for high and low conduct problem children. Teacher training focused on altering the whole classroom environment may be an effective strategy, even for children with significant conduct problems.     

The Treatment of Test Anxiety in Elementary School-Age Children

Test anxiety has a dramatic impact upon a surprisingly large segment of the school population. Although test anxiety has been extensively studied for decades, little research has focused on intervention programs for younger school children. This paper discussed the conceptual framework of test anxiety and the resulting intervention philosophy from these different theoretical formulations. Assessment procedures for children are reviewed. Different kinds of intervention programs are discussed, compared and evaluated. These include systematic desensitization, cognitive restructuring, and educational approaches such as study skills training and modeling. Recommendations are made to enhance the existing research. Suggestions for future research are presented.     

Parent as Saboteur in the Therapeutic Treatment of Children

Children present some unique challenges to the therapist regarding treatment. Unlike adult patients, they are obviously still dependent upon the parent for transportation, the payment of fees, and the success or failure of treatment. Thus the parents make the ultimate decision to continue or terminate treatment. But sometimes a parent's characterological problems are activated by their child's treatment. These diagnostic problems can be classified as envy, jealousy, competition, and narcissism. When any or all of these unresolved parental issues are touched by the treatment of their child, some parents become determined to sabotage therapy, despite the necessity of the treatment for their child. The author's intent is to identify the parental characterological issues for sabotaging therapy through both a theoretical analysis and a discussion of the particular methods parents employ to achieve this end. Identification of the various strategies for handling hostile parents and elaboration of various methods that the therapist may employ are discussed when parental sabotaging of treatment becomes a problem. Recommendations for particular interventions are suggested to illuminate the challenges the therapist faces with those parents whose intent is to sabotage treatment.     

The Voices of Therapists and Children Regarding the Inclusion of Children in Family Therapy: A Systematic Research Synthesis

In 1970, Nathan Ackerman challenged the field of marriage and family therapy to actively involve young children in the family therapy process. How has the field of marriage and family therapy responded to his challenge? Using a systematic research synthesis to review and critique the non-empirical and empirical literature in the area of children in family therapy, the author discovered that the field of marriage and family therapy has not responded to Ackerman's challenge in the way he may have hoped for nearly three decades ago. A summary of the literature's findings is provided and recommendations for future research, as well as implications, for the field of marriage and family therapy are discussed.     

Treatment Participation among Children with Conduct Problems and the Role of Telephone Reminders

Children with antisocial, aggressive and disruptive behaviour problems are among the most frequent referrals to mental health services. These young people and their families present with a range of adverse contextual factors and can prove challenging to engage. We examined the characteristics of children with conduct problems, treatment participation, and the impact of telephone reminder calls. Consecutive referrals (N=262) to two child and youth mental health services were randomly assigned to either a reminder call condition or service as usual. In comparison to referrals without conduct problems, conduct problem children presented with greater sources of psychosocial adversity, attended fewer initial appointments and were at greater risk of treatment refusal. Importantly, telephone reminder calls significantly increased treatment attendance, though only for participants with elevated conduct problems. Telephone reminder calls, however, had no impact on treatment refusal, regardless of conduct problem status. The findings highlight a straightforward approach for enhancing treatment participation among a group that has been challenging for mental health services.     

儿童幽门螺杆菌感染诊治方案的分析比较及决策

幽门螺杆菌(Helicobacter pylori,Hp)是儿童感染率很高的细菌之一,同时也是儿童慢性胃炎,消化性溃疡及功能性胃肠紊乱症致病因子,与胃癌和胃MALT淋巴瘤密切相关。本文通过比较分析儿童Hp感染各种诊查手段及治疗方案,为临床治疗决策提供借鉴,从而更好地治疗Hp感染。     

Mutual Help Groups, Perceived Status Benefits, and Well-Being: A Test with Adult Children of Alcoholics with Personal Substance Abuse Problems

A field experiment was conducted to examine the potential effects of mutual help group participation on perceived status benefits, depression, and substance use among adult children of alcoholics (ACOAs) with personal substance abuse problems. Participants were randomly assigned to attend either ACOA-specific mutual help group meetings or substance abuse education classes during the initial month that they were enrolled in a residential treatment program for low-income substance abusers. Analyses were based on assessments made at baseline, a 1-month posttest, and a 6-month follow-up. Results indicated that participation in the mutual help group promoted perceived status benefits, which in turn led to reductions in depression and substance use. These findings have clear implications for consumers of ACOA groups and can inform research on the social psychological underpinnings of different types of mutual help groups.     

The Construct Validity of the Utrecht Work Engagement Scale: Multisample and Longitudinal Evidence

This study investigated the factor structure and factorial group and time invariance of the 17-item and 9-item versions of the Utrecht Work Engagement Scale (UWES; Schaufeli et al. (2002b) Journal of Happiness Studies 3:71–92). Furthermore, the study explored the rank-order stability of work engagement. The data were drawn from five different studies (N = 9,404), including a three-year longitudinal study (n = 2,555), utilizing five divergent occupational samples. Confirmatory factor analysis supported the hypothesized correlated three-factor structure—vigor, dedication, absorption—of both UWES scales. However, while the structure of the UWES-17 did not remain the same across the samples and time, the structure of the UWES-9 remained relatively unchanged. Thus, the UWES-9 has good construct validity and use of the 9-item version can be recommended in future research. Moreover, as hypothesized, Structural Equation Modeling showed high rank-order stabilities for the work engagement factors (between 0.82 and 0.86). Accordingly, work engagement seems to be a highly stable indicator of occupational well-being.