Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment

Mental health systems need scalable solutions that can reduce the efficacy–effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers’ fidelity to evidence-based treatment models and children’s and caregivers’ engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.     

Quality home visits: Activities to promote meaningful interactions

Examination of and support for specific practices that promote high-quality home visiting are essential as family support programs continue to expand across the country. The current study used direct observation of 91 home visits across 41 home visitors to examine relations among interaction partners, content of the interactions, the home-visitors’ activities, and quality of home-visitors’ practices and family-members’ engagement within programs funded by the Maternal, Infant, and Early Childhood Home Visiting program. More time spent in triadic interactions focused on child-related content, as measured by the Home Visit Rating Scale-Revised, was related to higher quality of family engagement in home visits, as measured with the Home Visit Observation Rating Scales. Time spent in adult-focused interactions and administrative tasks, however, was related to lower quality of home-visiting practices and family engagement. Implications for research and practice are discussed.     

Infant mental health home visiting in the context of an infant—toddler court team: Changes in parental responsiveness and reflective functioning

This article describes an infant–toddler court team in Michigan, the community-based participatory research approach to the implementation evaluation, and the resulting changes in parenting. Like other court teams, Michigan's Baby Court is led by a science-informed jurist, and all service providers are knowledgeable about the developmental needs of young children and engage in collaborative communication throughout the case. Relationship-based treatment in the form of infant mental health home-visiting was provided to families. Sixteen parents participated in pre- and posttest evaluation visits to assess changes in parents’ reflective functioning and interactions with their child. Findings suggest improvements in parents’ responsiveness, positive affect, and reflective functioning, with moderate effects. Higher risk parents demonstrated significant changes in reflective functioning, as compared to those at lower risk. These findings add to and support the limited literature on the effectiveness of infant–toddler court teams, which include relationship-based and trauma-informed services.     

Vicarious Improvement Among Parents Participating in Child-Focused Cognitive-Behavioral Therapy for Anxiety

Parental variables likely have important and bidirectional influences on the etiology of child anxiety. Although some child-focused cognitive-behavioral therapy (CCBT) anxiety trials have found vicarious improvements among parents who participated in their children’s treatment, this is an understudied area. We hypothesized that parental variables (psychopathology, stress, and burden) will significantly decrease from pre- to post-CCBT and will be associated with child treatment response. We explored whether intervention delivery method—in-person CCBT versus parent-mediated bibliotherapy—influenced vicarious parental improvements. Parental variables decreased from pre- to post-CCBT and were associated with child treatment response. Effects did not interact with delivery method. Parent participation in anxiety CCBT may result in vicarious improvements for parents.     

An investigation into the temporal dimension of the Mozart effect: evidence from the attentional blink task

In the present study, we examined whether the 'Mozart effect' would influence participants' temporal attention using a visual attentional blink (AB) task that provides a reliable measure of the temporal dynamics of visual attention. The 'Mozart effect' refers to the specific claim that listening to Mozart's Sonata for Two Pianos in D Major, K.448 can improve the performance in spatio-temporal tasks. Participants had to try and identify two target digits (in their correct order of presentation) presented amongst a stream of distractor letters in three different conditions (presented in separate blocks of trials): while listening to the Mozart sonata played normally, while listening to the same Mozart sonata played in reverse, and while in silence. The results showed that the participants were able to detect the second target (T2) significantly more accurately (given the correct detection of the first target, T1) in the AB stream when the Mozart sonata was played normally than in either of the other two conditions. Possible explanations for the differential effects of Mozart's music being played normally and in reverse and potential confounds in previous studies reporting a facilitatory 'Mozart effect' are discussed. Our results therefore provide the first empirical demonstration supporting the existence of a purely temporal component to the 'Mozart effect' using a non-spatial visual AB task.     

Mutation at the TrkB PLC{gamma}-docking site affects hippocampal LTP and associative learning in conscious mice

Previous in vitro studies have characterized the electrophysiological properties and molecular events associated with long-term potentiation (LTP), but as yet there are no in vivo data from molecular-level dissection that directly identify LTP as the biological substrate for learning and memory. Understanding whether the molecular pathways required for learning are also those generating LTP when measured directly on the relevant circuit of a learning animal is clearly important, although so far has proved technically difficult. Here, for the first time, we combine highly defined genetic mouse models with behavior and in vivo recordings. We recorded the activity-dependent changes taking place at the CA3-CA1 synapses during the acquisition and extinction of a simple form of an associative learning task in mice carrying point mutations on specific docking sites of TrkB receptors (trkB(SHC), trkB(PLC)). The learning task consisted of a classical eyeblink conditioning using a trace paradigm. The conditioned stimulus (CS) consisted of a tone and was followed by a periorbital electrical shock as an unconditioned stimulus (US). The US started 500 msec after the end of the CS. We show that a single pulse presented to the Schaffer collateral-commissural pathway during the CS-US interval evoked a monosynaptic field excitatory postsynaptic potential (fEPSP) at the CA1 pyramidal cells, with a slope linearly related to learning evolution in controls and trkB(SHC) mutants, but the relationship was impaired in trkB(PLC) mice. These data support a link between the PLCgamma-docking site downstream of TrkB and the activity-dependent synaptic changes evoked at the CA3-CA1 synapses during associative learning in conscious mice, and indicate that TrkB PLCgamma-site-activated molecular pathway(s) underlie both associative learning and LTP triggered at the CA3-CA1 synapse.     

A preliminary examination of the intergenerational continuity of maternal psychopathic features

The study provided a preliminary test of the intergenerational continuity of maternal psychopathic features in a non-referred elementary aged sample of children. Consistent with dominant etiological models and recent behavioral genetics research, a direct association was expected between maternal and child affective features of psychopathy (i.e., callous-unemotional or CU traits). Potential mediators representative of alternative transmission mechanisms were assessed including parenting dysfunction, parental hostility/interpersonal insensitivity, and child impulsivity. Behavioral features of psychopathy were also assessed and were predicted to bear weaker and more indirect parent-child associations. A mixed sex sample of 83 children accompanied by a biological mother were administered a multi-informant rating-scale battery including separate parent (i.e., Levenson Self-Report Psychopathy Scale) and child (i.e., Antisocial Process Screening Device) measures of psychopathy. Consistent with prediction, a significant association was documented between maternal and child CU traits (r=.22). Additionally, a slightly weaker association and statistical trend (r=.21) was observed in the relation between maternal and child interpersonal features of the psychopathy construct. Contrary to prediction, all documented associations were fully mediated by parental hostility and parenting dysfunction. Given the preliminary nature of study findings, implications for developmental modeling and future intergenerational continuity research are discussed.     

MMPI-2 and MCMI-III characteristics of parental competency examinees

The MMPI-2 (Butcher et al., 2001) and the MCMI-III (Millon, Davis, & Millon, 1997) may contribute to understanding psychological functioning in parental competency examinees. In this study, we sought to identify MMPI-2 and MCMI-III characteristics of this population. We collected data regarding 127 individuals who underwent court-ordered parental competency evaluations. Although test results were generally consistent with findings from the child custody literature, MMPI-2 results indicated the highest Validity scale elevation on the L scale in contrast to the K scale elevations that have often been reported in the custody literature.     

The Short Mood and Feelings Questionnaire (SMFQ): A Unidimensional Item Response Theory and Categorical Data Factor Analysis of Self-Report Ratings from a Community Sample of 7-through 11-Year-Old Children

Item response theory (IRT) and categorical data factor analysis (CDFA) are complementary methods for the analysis of the psychometric properties of psychiatric measures that purport to measure latent constructs. These methods have been applied to relatively few child and adolescent measures. We provide the first combined IRT and CDFA analysis of a clinical measure (the Short Mood and Feelings Questionnaire—SMFQ) in a community sample of 7-through 11-year-old children. Both latent variable models supported the internal construct validity of a single underlying continuum of severity of depressive symptoms. SMFQ items discriminated well at the more severe end of the depressive latent trait. Item performance was not affected by age, although age correlated significantly with latent SMFQ scores suggesting that symptom severity increased within the age period of 7–11. These results extend existing psychometric studies of the SMFQ and confirm its scaling properties as a potential dimensional measure of symptom severity of childhood depression in community samples.