Ethics Consultation Quality Assessment Tool: A Novel Method for Assessing the Quality of Ethics Case Consultations Based on Written Records

Although ethics consultation is offered as a clinical service in most hospitals in the United States, few valid and practical tools are available to evaluate, ensure, and improve ethics consultation quality. The quality of ethics consultation is important because poor quality ethics consultation can result in ethically inappropriate outcomes for patients, other stakeholders, or the health care system. To promote accountability for the quality of ethics consultation, we developed the Ethics Consultation Quality Assessment Tool (ECQAT). ECQAT enables raters to assess the quality of ethics consultations based on the written record. Through rigorous development and preliminary testing, we identified key elements of a quality ethics consultation (ethics question, consultation-specific information, ethical analysis, and conclusions and/or recommendations), established scoring criteria, developed training guidelines, and designed a holistic assessment process. This article describes the development of the ECQAT, the resulting product, and recommended future testing and potential uses for the tool.     

Effects of a Brief Parenting Intervention In Shelters For Mothers And Their Children Experiencing Homelessness

This study was designed to examine the effectiveness of an evidence-based parenting program—Triple P Positive Parenting Program—in shelter settings for families experiencing homelessness. The intervention has not previously been evaluated in a shelter setting, where there is a critical need for evidence-based parenting programs. Using a within-group pre- and post-intervention with 3-month follow-up design, 39 mothers residing in a shelter with a child ages 2–6 years participated. Results of this preliminary study showed positive effects of Triple P Discussion Groups. There were significant improvements in mother-reported parenting practices and child behavior across time, but no change in child maltreatment risk as measured by the Brief Child Abuse Potential Inventory. Mothers rated satisfaction with the program high immediately after the group and again three weeks later. Results showed Triple P Discussion Groups are acceptable and have some positive effects for this vulnerable population in need of parenting support. We discuss implications of findings, limitations of the study (including a 33% attrition rate), and recommendations for further study.

     

Interactive Effects of Parental Separation and Socioeconomic Status on Child Sleep Quality and Child Development

Journal of Child and Family Studies - Prior research demonstrates an association between parental divorce and separation and a range of negative child outcomes, including sleep difficulties. We...     

A Brief,Hospital-Initiated Motivational Interviewing and Acceptance and Commitment Therapy Intervention to Link Postpartum Mothers Who Use Illicit Drugs With Treatment and Reproductive Care: A Case Report

Maternal substance use during the prenatal period often results in infants with compromised health outcomes. The American College of Obstetrics and Gynecology recommends screening, brief motivational interviewing, and referral to existing treatment for women who use illicit substances prenatally. However, many of these women do not present for prenatal care and are not identified as using substances until delivery of their infants, many of whom are admitted to the neonatal intensive care unit (ICU). We describe a case from a novel, hospital-initiated intervention study, Moms in ACTion (MIACT) that combines motivational interviewing (MI) and acceptance and commitment therapy (ACT) to target new mothers with an infant in the neonatal ICU who screen positive for illicit substance use prenatally or at delivery. The MIACT program consists of an adaptive intervention that includes up to three sessions. Initiation of substance use treatment and reproductive care via a gynecological visit are the primary targets of the intervention. Urine samples were collected at 2- and 6-month follow-up visits. The participant successfully completed the program, achieved both treatment outcomes, and had negative urine drug screens at follow-up visits. Improvements in readiness to change and psychological flexibility were also observed. The present case report of a new mother who used substances demonstrated feasibility for combining MI and ACT treatments and the potential for MIACT to increase treatment and contraception initiation, ultimately preventing future substance-exposed pregnancies.     

A Feasibility Study of Behavioral Activation for Major Depressive Disorder in a Community Mental Health Setting

Behavioral activation (BA) is a well-supported treatment approach, but little research has been conducted on the effectiveness of this treatment within publicly funded community mental health settings. We examined the feasibility of conducting a randomized trial examining the effectiveness of nine sessions of BA as a treatment for major depressive disorder (MDD) in a community mental health clinic (CMHC) setting. Following adaptation of a BA manual and training of BA therapists, 80 patients seeking treatment at a CMHC were randomized, with a 3:1 randomization rate of BA to nine sessions of treatment as usual (TAU). Feasibility assessments indicated that only one eligible patient refused randomization and, of patients who attended at least one session, the median number of sessions was six for the BA group and eight for the TAU group. Of three postbaseline monthly assessments, 71.3% (171/240) were successfully obtained. On average, patients in the BA condition completed homework assignments 83.9% of the time. Treatment fidelity ratings indicated that substantially more BA techniques were delivered in the BA group compared to the TAU group (d = 2.11). Measures of BA mechanisms improved significantly over time and these changes were significantly associated with change in depressive symptoms. These results indicate that it is feasible to conduct a randomized study of BA for MDD in a CMHC setting. In addition, the study reconfirmed the potential importance of theory-relevant BA mechanism variables. Following these findings, further investigation into the effectiveness of BA in this setting is needed.     

PARENTAL CHILDHOOD ADVERSITY,DEPRESSIVE SYMPTOMS,AND PARENTING QUALITY: EFFECTS ON TODDLER SELF‐REGULATION IN CHILD WELFARE SERVICES INVOLVED FAMILIES

Parents who are involved with child welfare services (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by K. Lyons‐Ruth, R. Wolfe, A. Lyubchik, and R. Steingard (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers assessed three times over a period of 6 months. At Time 1, parents reported on their childhood adversity and current depressive symptoms. At Time 2, parents’ sensitivity to their child's distress and nondistress cues was rated from a videotaped teaching task. At Time 3, observers rated children's emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported the hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn related to parent sensitivity to child distress, but not nondistress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to nondistress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families.     

Younger and older adults’ associative memory for medication interactions of varying severity

While older adults face various deficits in binding items in memory, they are often able to remember information that is deemed important. In Experiment 1, we examined how younger and older adults remember medication interactions of varying severity. There were no age differences in overall memory accuracy, but older adults’ performance depended on the severity of the interactions (such that the interactions associated with the most severe health outcomes were remembered most accurately) while younger adults’ did not. In Experiment 2, a similar task was designed to create interference in memory. Even with this more difficult task there were no age differences in recall accuracy, and both age groups remembered the interactions with the severe outcomes most accurately. These findings suggest that, under certain circumstances, older adults do not face deficits in associative recognition accuracy of information that varies in importance.     

Posttraumatic Growth in Individuals With Chronic Illness: The Role of Social Support and Meaning Making

This study aimed to assess the predictive nature of social support, meaning making (presence of meaning and search for meaning), and demographic factors on perceived posttraumatic growth (PTG) in a sample of adults living with chronic illness (N = 110). Regression analyses indicated that presence of meaning and gender served as the strongest predictors, together accounting for 22% of the variance in PTG. Presence of meaning also moderated the relationship between social support and PTG, supporting the unique contribution of meaning making on PTG.