Increasing the prevalence of successful children: The case for community intervention research

This paper makes a case for research on community interventions on child rearing. Sufficient evidence has accumulated about the development of children's problem behavior to justify evaluating efforts to reduce the prevalence of these problems in whole communities. The contextual risk factors for diverse child behavior problems are well understood, and interventions to ameliorate individual risk factors have been developed and evaluated. Because interventions with individual children have proven to be efficacious, it is now appropriate to direct energy toward reducing the prevalence of children with behavior problems. At the same time, existing interventions have limitations. Community interventions may be needed to modify the larger social context for families. This paper enumerates possible components of a community intervention to improve child-rearing outcomes. Existing evidence indicates that communities would benefit from making parent training and family support programs available to parents. Validated methods of identifying and remediating academic and behavioral problems in schools are available, but influencing schools to adopt them remains a problem. Community organizing could mobilize communities to allocate the resources necessary to support such parenting and schooling programs as well as encourage their adoption. Media campaigns could foster community support and directly influence parenting practices. Efforts to modify peer influences to use illicit substances have received empirical support; similar efforts may be relevant to preventing other problems. The development of a science of community interventions on child rearing is hampered by overreliance on randomized control trials. For this reason, two examples of time-series experimental evaluations of community intervention components are described here.     

The Zuni Life Skills Development Program: a school/community-based suicide prevention intervention

The Zuni Life Skills Development Program, an effective community-initiated and high-school-based suicide prevention intervention, is featured. Development and evaluation of this intervention are followed by note of the specific challenges associated with stabilizing the program. A more tribally diverse, culturally-informed model entitled the American Indian Life Skills Development Curriculum is then presented to illustrate a hybrid approach to the cultural tailoring of interventions. This curriculum is broad enough to address concerns across diverse American Indian tribal groups yet respectful of distinctive and heterogeneous cultural beliefs and practices. Finally, we reflect upon issues in community-based research that emerged during this collaboration.     

Computer-based dissemination: a randomized clinical trial of ePREP using the actor partner interdependence model

The most pressing challenge facing our field is to close the gap between the need for evidence based treatment and our ability to effectively provide it. We illustrate how an empirically supported treatment can be adapted for computerized administration to maximize the likelihood of widespread dissemination. This randomized clinical trial shows how computer-based treatments can be effectively used to increase flexibility in reaching target populations. Using the actor partner interdependence model, we found that, compared to those who received a placebo intervention, ePREP participants demonstrated better mental health and relationship functioning at a six-week follow up. Those who engaged more fully in the intervention and mastered the communication techniques generally experienced superior outcomes. Implications of and recommendations for computer-based dissemination are discussed.     

Exercise motivation in university community members: a behavioural intervention

The purpose of this study was to examine how exercise level, exercise motives, and barriers changed from the baseline phase to the follow-up phase after a behavioural and cognitive intervention aimed at increasing exercise. Seventy-five members of our university community (43 subjects in the control group and 32 in the experimental group), all of whom received cognitive feedback, agreed to complete the baseline phase. Only the experimental group received behavioural feedback and a free-access gym ticket with personal training in order to facilitate their adherence to exercise. The results suggest that a combination of behavioural and psychological techniques is an efficient strategy for increasing exercise level. In addition, the results showed that extrinsic motivation predominates the early stages of change-of-exercise behaviour, and that intrinsic motivation is important for progression towards maintenance. Subjects who decreased their exercise level increased their extrinsic exercise motivation and subjects who increased their exercise level decreased the barriers related to intrinsic motivation. These findings indicate that, in order to facilitate exercise adherence, feedback about motives for undertaking exercise is needed, combined with advice about how to improve physical condition. This combination could help eliminate certain barriers that hinder engaging in an active and healthy life-style.     

Self-administered behavioural family intervention for parents of toddlers: effectiveness and dissemination

This study examined the effectiveness of a self-administered behavioural family intervention (BFI) for parents of toddlers, within the context of a regular telephone counselling service provider. Telephone counsellors were trained in the delivery of BFI, and 110 mothers of toddlers completed the intervention. There were significant short-term effects of intervention in terms of child behaviour problems and parenting style, parenting confidence and anger. In addition, there were improvements in mother's personal adjustment, and lower levels of parenting conflict. The intervention effects were maintained at 3-month follow-up. The results provide support for the effectiveness of self-administered BFI, and have implications for the population level delivery of behavioural family interventions.     

Challenging body weight: evidence from a community-based intervention on weight,behaviour and motivation

The objective of this study was to examine the effectiveness of a 12 week weight loss intervention within a commercial fitness centre on body weight, moderate to vigorous physical activity (MVPA), dietary intake, and behavioural regulations for exercise and healthy eating. Using a quasi-experimental design, the intervention group received weekly coaching sessions and bi-weekly seminars designed to increase MVPA and improve dietary intake. Outcome variables were assessed at three time points over a six month period. Results showed a significant interaction for body weight (p = .04) and dietary changes (p < .05) following the weight loss challenge but were not maintained across the six month period. Changes in behavioural regulations favoured the intervention condition. Results imply that a 12 week weight loss challenge within a commercial fitness centre may be effective at prompting short-term weight loss and support the internalization of behavioural regulations specific to healthy eating and exercise.     

Resilience and successful community reintegration among female forensic psychiatric patients: a preliminary investigation

Research on resiliency and recovery in forensic psychiatric patients is still limited. Information pertaining to factors associated with successful community reintegration would contribute to a more comprehensive assessment of functioning and informed treatment planning that fits within a recovery approach of service provision. Using a retrospective design involving file reviews and a 3-year follow-up period, the authors investigated the rate of successful/unsuccessful community reintegration (defined by the presence or absence of an absolute discharge/readmission to hospital) in female forensic psychiatric patients (N = 48). The study evaluated the extent to which the risk and protective factors captured in the Short-Term Assessment of Risk and Treatability (START) predicted a range of positive and negative outcomes in the study sample. Results showed that 47.9% of the women qualified as having successfully reintegrated into the community, with the remaining 52.1% qualifying as still being in recovery. Successful individuals possessed significantly more protective factors and significantly fewer risk factors than individuals still in recovery. Furthermore, both the vulnerability and the strength scale of the START demonstrated good predictive validity, however we did not find evidence of incremental validity of the strength scale. Copyright © 2011 John Wiley & Sons, Ltd.     

Intensive family intervention in a community consultation framework

This article describes a form of mental health consultation to community workers who have reached a state of crisis in their work with unmotivated, multi-problem families. The central part of the consultation is a therapeutic intervention that draws on principles of time extension and network intervention. The consultant sees the family together with its community workers in a one-time, intensive meeting of up to six hours duration. This meeting is divided into three phases, aimed at achieving respectively (1) structural, (2) emotional, and (3) cognitive imbalancing of the family system. This creates a new situation, which hopefully will enable the community workers and the family to move out of the crisis in which they had become stuck.     

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention.

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.     

Behavioural group therapy for obsessive-compulsive disorder in Norway. An open community-based trial

The aim of the current study was to test the effectiveness of ERP-based 12 weeks group therapy for OCD patients in a community-based, general Norwegian outpatient clinic. The sample consisted of 54 patients diagnosed with OCD. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory (BDI) and the Spielberger State Anxiety Inventory (STAI-S) were administered before treatment, after treatment and at 3- and 12-month follow-ups. Analyses with mixed models for repeated measurements showed that group behavioural therapy offered to OCD patients significantly improved ratings of obsessive-compulsive symptoms, depression and anxiety. These improvements were maintained at 3- and 12-month follow-ups and an additional reduction in obsessive-compulsive symptoms was observed from post-treatment to 3-month follow-up. However, the delayed effect of therapy was no longer present at 12-month follow-up. The results also revealed that the patients had a lower chance for an increased outcome category (e.g. from unchanged to improved or recovered) with high scores on STAI-S at the given observation times (post-treatment, 3- and 12-months follow-ups). Depressive symptoms (BDI) at post-treatment and follow-ups had no significant influences on the three categories of outcome for OCD. In conclusion, the results indicate that behavioural group therapy can successfully be delivered to patients with considerable comorbidity in a real world setting conducted by therapists with limited training in the CBT.     

Work-anxiety-coping intervention improves work-coping perception while a recreational intervention leads to deterioration: Results from a randomized controlled trial

Work-anxieties are costly and need early intervention. The perception of being able to cope with work is a basic requirement for work ability. This randomized controlled trial investigates whether a cognitive behavioural, work-anxiety-coping group (WAG) intervention leads to better work-coping perception than an unspecific recreational group (RG). Heterogeneous people in medical rehabilitation, who were due to return to work, were interviewed concerning their work-anxieties, and either randomly assigned to a WAG (n = 85) or a RG (n = 95). The participants (with an average of 50 years old [range 23–64]; 51% women; 70% workers or employees, 25% academics, 5% unskilled) followed the group intervention for four or six sessions. The perceived work-coping was assessed by self-rating (Inventory for Job-Coping and Return Intention JoCoRi) after each group session. Although participants had a slight temporary decrease in work-coping after group session two (from M₁ = 2.47 to M₂ = 2.28, d_Cohen = ?.22), the WAG led to the improvement of perceived work-coping over the intervention course (from M₁ = 2.47 to M₆ = 2.65, d_Cohen = .18). In contrast, participants from the RG reported lower work-coping after six group sessions (from M₁ = 2.26 to M₆ = 2.02, d_Cohen = ?.18). It is considered that people with work-anxieties need training in work-coping. By focusing on recreation only, this may lead to deterioration of work-coping. Indeed, intervention designers should be aware of temporary deterioration (side effects) when confronting participants with work-coping.     

My Disaster Recovery: a pilot randomized controlled trial of an Internet intervention

Abstract

This pilot study tested the efficacy of the My Disaster Recovery (MDR) website to decrease negative affect and increase coping self-efficacy. Fifty-six survivors of Hurricane Ike were recruited from a larger study being conducted at the University of Texas Medical Branch at the first anniversary of the storm. Restricted randomization was used to assign participants to the MDR website, an information-only website, or a usual care condition. Group×time interactions indicated that MDR reduced participant worry more than the other conditions. A similar trend was also identified for depression. Both websites were accessed a small to moderate amount and participants reported mixed satisfaction for both websites. Although the effect sizes for worry and depression were in the moderate to large range, small sample size and timing of the intervention qualify the findings. These preliminary findings encourage further evaluation of MDR with a larger, demographically diverse sample and indicate that the MDR website might be helpful in reducing worry and depression.     

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.     

Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial.

A longitudinal randomized trial tested the self-determination theory (SDT) intervention and process model of health behavior change for tobacco cessation (N = 1006). Adult smokers were recruited for a study of smokers' health and were assigned to intensive treatment or community care. Participants were relatively poor and undereducated. Intervention patients perceived greater autonomy support and reported greater autonomous and competence motivations than did control patients. They also reported greater medication use and significantly greater abstinence. Structural equation modeling analyses confirmed the SDT process model in which perceived autonomy support led to increases in autonomous and competence motivations, which in turn led to greater cessation. The causal role of autonomy support in the internalization of autonomous motivation, perceived competence, and smoking cessation was supported.     

A randomized trial of a brief primary-care-based intervention for reducing at-risk drinking practices.

This randomized trial evaluated an intervention for reducing at-risk drinking practices in a sample of 307 patients. Eligible drinking patterns included chronic drinking (> or = 2 drinks per day in the past month), binge drinking (> or = 5 drinks per occasion at least twice in the past month), and drinking and driving (driving after > 2 drinks in the past month). Members of the intervention group received a message from their physician during their regularly scheduled visit, a self-help manual, written personalized feedback, and up to 3 telephone counseling calls. Dropout was significantly higher in the intervention than control group.