IMPLEMENTATION OF AN EVIDENCED‐BASED PARENTING PROGRAM IN A COMMUNITY MENTAL HEALTH SETTING

The process of mental health intervention implementation with vulnerable populations is not well‐described in the literature. The authors worked as a community‐partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low‐income community. We used qualitative ethnographic methods to document the adaption of an evidence‐based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0‐ to 84‐month‐old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.     

“Part of me feels like there must be something missing”: a phenomenological exploration of practising psychotherapy as a clinical psychologist

The experience of practising psychotherapy as a clinical psychologist was explored through a small number of in-depth interviews. Using Interpretative Phenomenological Analysis, three main themes were identified: “Feeling there’s something missing”, “Being able to get in there emotionally” and “Needing somewhere to go for support”. This study suggests that training for psychotherapy work can be experienced as piecemeal and fragmented, contributing to professional self-doubt, with clinical psychologists seeking more structured, cohesive training in this area. It also suggests that engagement in personal therapy can contribute to greater emotional capacity as a psychotherapy practitioner, although clinical psychologists can fear engaging in something that is unfamiliar. In addition, the psychologists highlighted the felt necessity of safe and satisfying supervision for resilient practice.     

Teaching oddity and insertion to Head Start children: An economical cognitive intervention

Two interventions were offered to Head Start preschoolers. Half of the children played numerous learning set games designed to teach the children (1) the oddity principle and (2) how to insert objects into a series. Mastery of these concepts is theoretically an important aspect of school readiness. The other half of the children engaged in the I Can Problem Solve (ICPS) exercises, a program designed to increase the children's competency in recognizing and responding to other people's feelings. The children who played the learning set games became superior at oddity and insertions with manipulable objects, and generalized these games to workbook-like formats resembling those encountered in kindergarten. They also scored higher on the numeracy and memory scales of the McCarthy Scales of Children's Abilities, indicating that mastery of oddity and insertions may have served as foundations for further cognitive growth. The children who participated in the ICPS exercises became superior at creating solutions to interpersonal problems, as measured by the Preschoolers Interpersonal Problem Solving Scale. The differences in the outcomes indicate that both interventions were successful in their own domains. The advantage the cognitive intervention produced on the McCarthy Scales suggests that oddity and insertion abilities may be a foundation in fact as well as in theory for general cognitive growth at this age.     

Introducing Spirituality into Psychiatric Care

Spirituality is important to many psychiatric patients, and these patients may be moved toward recovery more effectively if their spiritual needs are addressed in treatment. This, however, is rarely given expression in the psychiatric services of teaching hospitals. In order to develop this potential area of improved care, we (1) evaluated the differential attitudes of patients and psychiatric trainees toward the value of spirituality in the recovery process, (2) established a program of group meetings conducted by psychiatric residents and staff where patients can discuss how to draw on their spirituality in coping with their problems, and (3) established related training experiences for psychiatric residents. The results and implications of these three initiatives are presented.     

Risky Behavior in Affluent Youth: Examining the Co-occurrence and Consequences of Multiple Problem Behaviors

Children of affluent parents are often excluded in psychological research as they are considered to be at “low risk”; however, research is beginning to suggest that this previously under-studied population may be at risk for developing multiple problem behaviors, including substance use and externalizing problems. The current study aimed to extend the application of Problem Behavior Theory (PBT) to a sample of affluent adolescents by examining the extent to which these behaviors co-occurred and were associated with negative outcomes. Data were collected from 1,147 high school students living in an affluent community via anonymous questionnaires regarding their engagement in various problem behaviors. PBT was supported in this sample, and youth who engaged in multiple problem behaviors reported experiencing more negative outcomes than youth who did not engage in these behaviors. The findings of this study support the generalizability of PBT and also highlight the importance of continuing to study affluent youth in addition to traditionally high-risk populations.     

Health-Related Quality of Life in Children and Adolescents Following Traumatic Injury: A Review

This paper comprehensively reviews the published literature investigating health-related quality of life (HRQOL) following general traumatic injury in individuals between birth and 18?years. Studies were not considered if they primarily compared medical treatment options, evaluated physical function but not other aspects of HRQOL, or focused on non-traumatic wounds. Specific injury types (e.g., burn injury) were also not included. A total of 16 studies met criteria. Participants were age 1-18?years, with 12 studies considering children 5?years of age or older. Males were overrepresented. Injury severity averaged mostly in the moderate range. HRQOL deficits were noted in injured samples in all studies except the two with the longest time to follow-up (6-11?years). Some improvement was seen 6?months to 2?years after injury. Factors associated with HRQOL deficits were investigated, with acute and posttraumatic stress disorder symptoms showing the strongest relationship. Research to date in this area is impressive, particularly the number of studies using prospective longitudinal investigations and validated measures. Challenges remain regarding methodologic differences, assessment of preinjury status, retention of participants, and management of missing data. Suggested future directions include extension of follow-up duration, utilization of pediatric self-report when possible, inclusion of younger children, and development of intervention programs.     

Facial affect recognition deficits: A potential contributor to aggression in psychotic illness

The current literature suggests a relationship between psychosis and the likelihood of engaging in aggressive behavior, though the factors involved are unclear. In this paper we use a social information processing framework to consider mediators of aggressive behavior in psychosis, especially facial affect recognition (FAR) deficits. The theoretical underpinnings of aggressive behavior are explored using the General Aggression Model (GAM) and FAR deficits are posited as a possible contributor to increased aggression in psychosis. Current research investigating the relationship between FAR, psychosis, and aggression is critically examined, and the role of potential confounding variables including positive symptoms, psychopathic personality traits, childhood trauma, and substance use briefly explored. In conclusion, we argue that socioemotional processing deficits, such as impaired FAR, are a fruitful area for research aimed at understanding, and hence reducing the risk of violence in psychosis.