Parent satisfaction with neuropsychological consultation after pediatric mild traumatic brain injury

Few studies have focused on consumer satisfaction following neuropsychological evaluation. We sought to examine parent satisfaction with neuropsychological consultation following a mild traumatic brain injury (TBI) in school-age children. We surveyed 71 parents of 8- to 17-year-olds participating in a prospective longitudinal study examining neuropsychological consultation as an intervention for persistent postconcussive symptoms. Children had sustained injuries between 2 and 12 months prior to enrollment. Neuropsychological consultation occurred on average 5 months post-injury. Parent satisfaction data were collected via telephone approximately 4 months after the neuropsychological consultation. The vast majority of parents were quite satisfied with the service (e.g., 94% overall satisfaction rate; 96% rated the service as good or excellent). Satisfaction rates were associated positively with time since injury and negatively with parental education. No other child, parent, or provider variable correlated with satisfaction. The results add to the relatively sparse literature on parent satisfaction with neuropsychological evaluation. A pressing future need in pediatric neuropsychology is to examine the satisfaction of other consumers of the service, including healthcare personnel, educators, and the child patients themselves.     

Family-centered intensive case management: A step toward understanding individualized care

New York State's initial attempt at individualizing services occurred within the context of an experiment. We randomly assigned children 5–12 years old who were referred for out-of-home placement in treatment foster care to either treatment foster care, Family-Based Treatment (n=15), or to Family-Centered Intensive Case Management (FCICM) (n=27). FCICM used teams of case managers and parent advocates to provide in-home services. Flexible service dollars, respite care, and behavior management skills training were available to assist teams in individualizing care. Preliminary outcomes indicate that children in FCICM are doing as well or better than children assigned to FBT in their functioning and symptom reduction. Parents of children in FCICM have made gains, although not at a statistically significant level, in behavior management skills and family strengths that allow them to provide care for their children at home.     

Family Management of Pediatric Cancer: Links with Parenting Satisfaction and Psychological Distress

Research has long acknowledged the disruptions posed by pediatric cancer diagnosis and treatment to family life. Nonetheless, the mechanisms through which the family response influences parents’ mental health in this adverse context are not fully understood. The main goal of the present study was to examine the direct and indirect links, via parenting satisfaction, between family condition management and psychological distress of parents of children with cancer. Participants were 201 parents (86.6% mothers) of children/adolescents diagnosed with cancer who completed self‐report questionnaires assessing family condition management (family life difficulty and parental mutuality), parenting satisfaction, and psychological distress (anxiety and depression). Structural equation modeling was used to test the proposed mediation model. The results showed that parenting satisfaction mediated the association between both the family condition management dimensions (family life difficulty and parental mutuality) and depression. Specifically, greater family life difficulties and lower parental mutuality were associated with lower parenting satisfaction, which, in turn, was associated with higher levels of depression. Additionally, greater family life difficulties and lower parental mutuality were directly linked to higher levels of anxiety. Multigroup analyses suggested that the model was valid across patient age groups (children vs. adolescents) and treatment status (on vs. off‐treatment). These findings reinforce the need for family‐ and parent‐based interventions in the pediatric oncology field. Interventions that target families’ difficulties and promote their resources are likely to foster parenting satisfaction and psychological adjustment.     

Family functioning and involvement in home visiting: Examining program characteristics as moderators to support retention in services

Developing strategies to improve retention in home visiting programs is critical to their success. The purpose of the study is to examine how the content provided during home visits moderates the association between family risks (economic, household functioning, and conflict) and retention in services. Parents (n = 1,322) voluntarily enrolled in Healthy Families America (n = 618) and Parents as Teachers (n = 704). Family characteristics were collected using the Family Map Inventories. Multilevel analyses showed a moderating impact of the time home visitors spent supporting parent–child interaction for all family risks examined. Moderating effects demonstrated a stronger positive association between focusing on the parent–child relationship and retention at 6 and 12 months for parents demonstrating greater needs. There were no moderating effects of child development content or case management activities with retention at 6 and 12 months. Together, families were more likely to stay in services when home visitors focused on parent–child interaction and child development, but less likely retained with more case management. Parents with greater risks were more likely to remain in services with more time focused on supporting parent–child interactions. Findings suggest the need to support our home visiting workforce in their work to promote healthy parent–child relationships.     

A Preliminary Study of Activation,Stress, and Self-Management of Parents of Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) and developmental disabilities are high users of services, yet very little is known about how parents of these children interact with the health care system. Further, compared to parents of children with other developmental disabilities, parents of children with ASD experience more stress and dissatisfaction with services. Current efforts for improving services point to a need for understanding caregivers’ perceptions of their own health-care related beliefs and actions. Activation is a construct that measures the belief, knowledge, action, and persistence of managing one’s health care needs. The objective of this preliminary study was to evaluate the activation of parents of children with ASD using an adapted parent activation measure (PAM) for children with developmental disabilities called the PAM-DD. Data were collected from parents who received treatment as usual from a community-based outpatient treatment planning service for children with ASD. PAM-DD scores were compared with parent ratings of stress, self-management, and service satisfaction. Results indicated that increased activation correlated positively with parent report of satisfaction and ability to self-manage child issues such as eating, sleeping, and behavior and correlated negatively with parenting stress. The study of activation shows promise as a feature of quality of care for parents of children with developmental disabilities.     

The Effects of the <Emphasis Type="Italic">Nobody’s Perfect</Emphasis> Program on Parenting Resourcefulness and Competency

We conducted an evaluation of Nobody’s Perfect Program involving 71 participants from Peterborough County, Canada. Prior to the program, parents completed demographic information, along with self-report measures assessing the types of interactions with their children, parent resourcefulness, knowledge and use of resources, parent competency and self-efficacy, which were completed again after the program and at a two month follow-up testing. In comparison to parents not earning certificates, parents earning certificates were younger and more likely to have completed previous parenting programs. As well, parents earning certificates demonstrated and maintained an increase in parenting resourcefulness, warm/positive parent-child interactions, sense of parenting competency and satisfaction, and use of community resources. The more sessions parents attended, the better their parenting resourcefulness and warm/positive parent-child interactions on completion and at follow-up, and the less their angry and punitive parenting at follow-up. Parents who had attended parenting programs before had higher parenting resourcefulness scores at entry. They left the program with increased levels of parenting resourcefulness, better parent-child interactions, and more effective child management skills. A number of recommendations are suggested to help facilitators of the program enhance service delivery and improve parental outcomes.     

Mental health service utilization among Puerto Rican children ages 4 through 16

This paper examines those children receiving mental health services in Puerto Rico, their demographic and psychosocial characteristics, and describes service providers and nature of facilities. The survey was done on a probability sample of children ages 4 through 16 across the island of Puerto Rico (N=777). Need for services was clinically defined as presence of a DSM-III diagnosis and functional impairment. The overall rate of service utilization for Puerto Rican children was 6% (26.2% of definite cases and 5.1% of probable cases). In most cases services were provided by psychologists and/or social workers, and they were mainly provided in schools and general medical facilities. In over 60% of the children assessed as cases, who did not receive services, the reason, given by the parent was that they considered the problem not serious. Factors associated with service utilization were measures of psychopathology, teacher's perceived need, and parental rates of criticism and hostility. These findings suggest that there is a need for more research on the motivating factors for service use (impairment and parental criticism). Teachers could benefit from receiving special training to help them readily recognize behavioral problems in children, communicate them to parents and set up services alternatives.     

Mothers,Fathers, Gender Role,and Time Parents Spend with Their Children

To examine the relationships among the sex of the parent, gender role, and the time parents spend with their children, 272 parents completed the Bem Sex-Role Inventory, a questionnaire about the time spent with their children, and a demographics questionnaire. Analyses indicated that neither the sex of the parent nor gender role was predictive of the amount of time parents were spending in direct interaction with or being accessible to their children. The sex of the parent, qualified by earning status, was predictive of the level of responsibility parents had for child-related activities. Further, the sex of the parent, qualified by femininity, was predictive of parental satisfaction with level of child-related responsibilities. These results emphasize the importance of examining parental characteristics in relation to the time parents spend with their children and their levels of responsibility for child-related activities.     

Predictors of perceived satisfaction with parental control in Chinese adolescents: a 3-year longitudinal study

Over three consecutive years, 2,559 Chinese adolescents (mean age = 12.65 years at Wave 1) responded to instruments assessing their trust of parents, perceived parental trust of the children, readiness to communicate with the parents, and satisfaction with parental control. Results showed that mutual trust between the parents and their adolescent children and the children's readiness to communicate with the parents were related to perceived satisfaction with parental control at Time 1, Time 2, and Time 3. Although readiness to communicate with the parents and mutual trust between the parents and their adolescent children predicted perceived satisfaction with parental behavioral control and its change over time, trust of the parent was the strongest predictor. While the influence of trust of the father on satisfaction with paternal control was stronger for adolescent girls than for adolescent boys, influence of paternal trust on satisfaction with paternal control was stronger for adolescent boys than for adolescent girls.     

Empowering Parents: The Use of the Parent as Researcher Paradigm in Early Intervention

Whilst family-focussed models of service delivery are proving more effective in early intervention, it is the parents who ultimately carry the burden of responsibility. They often evolve their own strategies for coping with difficulties and solving problems within a family context. Through case study analysis, I report on some of the key outcomes of early intervention for families of very young children with disabilities. The analysis challenges traditional definitions of the family and suggests a recontextualisation of this concept. Similarly parental perceptions of the style of early intervention services are contrasted with those models reported to be effective by professionals. In striving for optimal effectiveness in early intervention, the unique knowledge and understanding of parents is pivotal, and ways are suggested of objectively collecting and collating that knowledge to inform practice and identify important research questions. This case study analysis has led to the evolution of the parent as researcher paradigm, and the implications for the practical implementation of this model will be considered.     

Predictors of changes in child behaviour following parent management training: Child,context, and therapy factors

This non‐randomised study examined a set of predictive factors of changes in child behaviour following parent management training (PMTO). Families of 331 Norwegian girls (26%) and boys with clinic‐level conduct problems participated. The children ranged in age from 3 to 12 years (M_age = 8.69). Retention rate was 72.2% at post‐assessment. Child‐, parent‐ and therapy‐level variables were entered as predictors of multi‐informant reported change in externalising behaviour and social skills. Behavioural improvements following PMTO amounted to 1 standard deviation on parent rated and ½ standard deviation on teacher rated externalising behaviour, while social skills improvements were more modest. Results suggested that children with higher symptom scores and lower social skills score at pre‐treatment were more likely to show improvements in these areas. According to both parent‐ and teacher‐ratings, girls tended to show greater improvements in externalising behaviour and social skills following treatment and, according to parents, ADHD symptomology appeared to inhibit improvements in social skills. Finally, observed increases in parental skill encouragement, therapists' satisfaction with treatment and the number of hours spent in therapy by children were also positive and significant predictors of child outcomes.     

Development and preliminary validation of the Paediatric Awareness Questionnaire for children and adolescents with traumatic brain injury

There is a lack of validated measures for assessing self-awareness of deficits after pediatric traumatic brain injury (TBI). The current study aimed to develop and examine the psychometric properties of the Paediatric Awareness Questionnaire (PAQ), and investigate factors related to self-awareness. The PAQ was administered to 32 children aged 8–16 years with mild to severe TBI (72% male, M age = 11.75, SD = 2.9), their parents, and treating clinicians, and to 32 age- and gender-matched typically developing controls and their parents. Children with TBI and their parents also completed the Knowledge of Injury Checklist (KIC), and parents completed the Depression Anxiety and Stress Scale 21. The PAQ was found to have fair to excellent (α = .79–.97) internal consistency for all versions across both groups and good concordance between parent and clinician total scores (ICC = .78). There was also evidence of convergent validity between the PAQ and KIC for both child (r = ?.45, p < .05) and parent ratings (r = ?.66, p < .001). Poorer self-awareness was significantly related to younger age at injury for the TBI group and lower parental education for the total sample. ANCOVA identified that children with TBI demonstrated significantly poorer awareness than controls after controlling for parental education. Children with TBI typically overestimated their functioning compared to their parents, whereas typically developing children tended to rate their functioning lower than their parents. These findings provide preliminary support for the reliability and validity of the PAQ for assessing self-awareness after pediatric TBI.     

The Intensive Mental Health Program: Development and Structure of the Model of Intervention for Children with Serious Emotional Disturbances

In order to meet the challenging needs and behaviors of children with Serious Emotional Disorders (SED), a school and community based Intensive Mental Health Program (IMHP) was developed and evaluated. We describe the conceptual framework, treatment principles, and model for service delivery for psychological and educational interventions under the umbrella of the IMHP. The program illustrates a model of comprehensive services for children with SED.     

Research to Practice: Implementation of Family School Success for Parents of Children With ADHD

“Family-School Success” (FSS) is an efficacious intervention improving the home and school functioning of children with ADHD in grades 2–6. An extension of this intervention designed for a younger population also showed positive effects for kindergarten and first grade students in a pilot study. Following the completion of these trials, FSS was implemented in a fee-for-service tertiary care ADHD center. The implementation process included adapting the manual and treatment procedures to be feasible outside the structure and support of a federally funded randomized control trial (RCT). The current study examines the process of adapting the treatment protocol and examines the acceptability and effectiveness of the adapted FSS, as well as predictors of family treatment response including parent engagement in treatment (as measured by attendance and homework adherence). A case study illustrates the adaptations to the intervention and its implementation in the clinic-based setting. In line with findings from clinical trials, families reported high satisfaction with the adapted FSS intervention and showed significant improvement in parental self-efficacy, child academic homework performance, and reduction in child impairment. Additionally, as in the initial FSS RCT, parental attendance in the adapted FSS program predicted child attention to academic homework, controlling for parental adherence to between-session homework. Furthermore, controlling for attendance at FSS sessions, parent adherence to between-session homework assignments predicted improvements in parent self-efficacy as well as child’s homework productivity. These results replicate those of the original RCT and confirm that both session attendance and between-session homework completed are important for improvement during the program. Overall, this study provides support for the acceptability and effectiveness of this treatment model and suggests that future work toward dissemination to community-based settings would be worthwhile.     

Children's Earliest Experiences with Death: Circumstances,Conversations, Explanations,and Parental Satisfaction

Parents (n = 140) of children 2 to 7 years responded to an online survey regarding their children's experiences and conversations about death. A total of 75% of parents indicated that they had spoken to their child about death, and the majority of conversations were first initiated when children were between 3 and 3.5 years of age. Binary logistic regression analysis was used to explore factors that could predict conversations about death. Parents (n = 88) provided narratives of the explanations of death that they gave their child and subsequently reported their level of satisfaction with their explanation. The content of the explanations was coded and examined in relation to children's age and parental satisfaction. Results revealed that parents who provided explanations to a continued existence after death reported significantly higher levels of satisfaction than those parents who discussed the absence of a future physical relationship after death. Finally, explanations of a continued existence were not always in reference to an afterlife and could include discussing the memory of the deceased or their continued impact even after death. Thus, when talking to young children about death, parents may feel greater satisfaction in finding ways to discuss the continued legacy of those who have died compared to more biological explanations. Copyright © 2014 John Wiley & Sons, Ltd.     

The California Linkages Program: Doorway to Housing Support for Child Welfare‐Involved Parents

Housing instability can complicate parents’ efforts to provide for their children. Child welfare service agencies have had difficulty adequately serving parents’ housing needs due to limited and constrained funding streams. This article integrates the voices of four important stakeholders to illuminate how an innovative model of service system coordination called Linkages addresses housing needs for child welfare‐involved parents eligible for public assistance. Facilitated by Linkages, these parents can receive supportive housing services through programs affiliated with the California public assistance program CalWORKs. Personal narratives reflecting the diverse perspectives of stakeholders in the Linkages collaboration—the statewide program director, a child welfare services coordinator, a CalWORKs caseworker, and a parent program participant—shed light on how the collaboration assists parents in attaining case plan goals, and highlights some of the factors facilitating and hindering effective collaboration between the agencies involved. Stakeholders emphasized the value of flexible service approaches, the intensity of the efforts required, the role of advocacy, and the importance of a shared vision between agencies working together to provide housing supports.     

Family functioning and psychopathology among adolescents with severe emotional disturbances

Family psychosocial functioning and its relation to psychopathology among adolescents with severe emotional disturbances (SED) was assessed. Subjects were 353 adolescents with SED, ages 12–18, and their parents. During a semistructured interview, adolescents were administered Family Adaptability and Cohesion Evaluation Scale (FACES-III), Diagnostic Interview Schedule for Children-Child Version (DISC-C), and the Self-Derogation Scale. Parents were administered FACES-IIII and the Child Behavior Checklist (CBCL) in a phone interview. Results indicated that on the FACES-IIII cohesion dimension, both parents and adolescents perceived their family relations as more disengaged and less connected than did normative families (p < .001). In contrast, only parent FACES-IIII adaptability scores were significantly more extreme than a normative sample (p < .01). Additionally, both parent and adolescent cohesion scores were significantly correlated with adolescent psyehopathology measures: DISC-C conduct disorder (p < .01), depression (p < .05), alcohol/marijuana (p < .01), and CBCL externalizing symptoms (p < .01). These relationships did not deviate from linearity. We gratefully acknowledge Eric C. Brown, Sue Greer, and Sharon P. Lardieri for assistance in data management of this project. Preparation of this article was supported by grant H133B90004-01 from the National Institute on Disability Rehabilitation Research and the National Institute of Mental Health.     

Long Term Outcomes to Family Caregiver Empowerment

The Vanderbilt Caregiver Empowerment Project evaluated a training program designed to enhance empowerment of caregiver and their subsequent involvement in the mental health treatment of their children. The intervention utilized a multi-component parent training curriculum that was designed to enhance: (a) knowledge of the service system; (b) skills needed to interact with the mental health system; and (c) the caregiver' s mental health services self-efficacy designed to improve caregivers beliefs in their ability to collaborate with service providers. The resulting increased empowerment was hypothesized to increase caretaker involvement, which should affect service use and ultimately the mental health status of the child. A randomized design was used to test the effectiveness of this model with caregivers of children receiving mental health services. The results one-year after the training replicated the intermediate outcomes of the project conducted 3-months after the training. The initial training continued to significantly influence the parent's knowledge and mental health services self-efficacy. However, the intervention had no effect on caregiver involvement in treatment, service use or the mental health status of the children.     

Parental Perceptions of Services Provided for Children with Autism in Jordan

Providing formal support for children with autism and their parents is important and mandatory to improve children’s abilities and enhance the capabilities of parents. The present study attempted to investigate the perceptions of parents of children with autism regarding the services provided in Jordan. A questionnaire consisting of five sections was designed and distributed to a sample of 60 parents of children with autism (5–18 years old) among four special education institutions in Jordan. The questionnaire addressed five domains: demographics, type and number of received services, methods and difficulties of obtaining services, parents’ satisfaction, and parents’ perceived needed services. The results revealed that the service delivery system with which parents interacted was composed of multiple places and providers, but had several difficulties. Parents participating in this study expressed an average satisfaction with the received services. Issues pertaining to the cost of services, parents-professional partnerships, and overall quality of services were seen by parents as sources of low satisfaction. On the other hand, parents expressed the need for early intervention, family counseling, and community awareness services. Further suggestions and implications are presented in the study.