System of Care Development in Children’s Mental Health: Lessons Learned from a Process Evaluation

Despite ongoing public calls for reform, the mental health needs of many children with psychological, emotional and behavioral disorders remain unmet. In response, providers continue to seek effective alternatives to institutional treatment by implementing comprehensive systems of care. The Children’s Enhancement Project (CEP) is a collaborative effort to provide holistic, community-based mental health services for children with an individualized, flexible, family-driven approach. We conducted a process evaluation of CEP’s early stage development and implementation utilizing both qualitative stakeholder interviews and quantitative survey components. The current article describes that evaluation and highlights the challenges and potential solutions encountered in developing a system of care. The lessons learned regarding system of care development, including the importance of a shared vision, establishing programmatic guidelines, achieving collaboration, and addressing sustainability concerns, are discussed.     

Children Exposed to the Arrest of a Family Member: Associations with Mental Health

The arrest of a parent or other family member can be detrimental to children’s health. To study the impact of exposure to the arrest of a family member on children’s mental health and how said association may change across developmental periods, we examined baseline data for children (birth through 11 years) entering family-based systems of care (SOC). Children exposed to the arrest of a family member had experienced significantly more 5.38 (SD = 2.59) different types of potentially traumatic events (PTE) than children not exposed to arrest 2.84 (SD = 2.56). Multiple regression model results showed that arrest exposure was significantly associated with greater behavioral and emotional challenges after controlling for children’s age, gender, race/ethnicity, household income, caregiver’s education, parenting factors, and other PTE exposure. Further analyses revealed differences in internalizing and externalizing behaviors associated with arrest exposure across developmental levels. This study highlights some of the mental health challenges for children exposed to the arrest of a family member, while adding to our knowledge of how such an event affects children across different developmental periods. More trauma-informed, developmentally appropriate systems need to be in place at all levels to assist children and families experiencing arrest.     

Seeking the boundary of boundary extension

Boundary extension (BE) is a remarkably consistent visual memory error in which participants remember seeing a more wide-angle image of a scene than was actually viewed (Intraub & Richardson, Journal of Experimental Psychology: Learning, Memory, and Cognition 15:179–187, 1989). Multiple stimulus factors are thought to contribute to the occurrence of BE, including object recognition, conceptual knowledge of scenes, and amodal perception at the view boundaries (Intraub, Wiley Interdisciplinary Reviews: Cognitive Science 3:117–127, 2012). In the present study, we used abstract scenes instead of images of the real world, in order to remove expectations based on semantic associations with objects and the schematic context of the view. Close-angle and wide-angle scenes were created using irregular geometric shapes rated by independent observers as lacking any easily recognizable structure. The abstract objects were tested on either a random-dot or a blank background in order to assess the influence of implied continuation of the image beyond its boundaries. The random-dot background conditions had background occlusion cues either present or absent at the image border, in order to test their influence on BE in the absence of high-level information about the scenes. The results indicate that high-level information about objects and schematic context is unnecessary for BE to occur, and that occlusion information at the image boundary also has little influence on BE. Contrary to previous studies, we also found clear BE for all conditions, despite using scenes depicting undetailed objects on a blank white background. The results highlighted the ubiquitous nature of BE and the adaptability of scene perception processes.     

ADHERENCE TO DISCRETE‐TRIAL INSTRUCTION PROCEDURES BY RURAL PARENTS OF CHILDREN WITH AUTISM

Parents of children with autism spectrum disorders may not attempt treatment, even when effective treatment options are available. Little is known about how to improve frequency of attempts to implement treatment (‘treatment adherence’). We provided 32 rural parents of young children with autism spectrum disorders with either written or video training materials about how to implement discrete‐trial instruction and compared parental adherence between the written (control) and video (experimental) groups. Parents who received video instructions adhered to the training procedures to a significantly greater extent than did parents who received written instructions, suggesting that instruction format is a predictor of training success. Copyright © 2014 John Wiley & Sons, Ltd.     

ASD in Females: Are We Overstating the Gender Difference in Diagnosis?

Autism spectrum disorder (ASD) is predominantly diagnosed in males. In explaining the differential rate of occurrence in males and females, biogenetic models have been proposed and studied, often to the exclusion of potential social or cultural factors that may influence different rates of diagnosis across the genders. In this theoretical paper, we consider sociocultural influences that may contribute to the differential expression of ASD in females and partially explain potential underidentification of ASD in females. Based on our synthesis of the extant literature, we propose that ASD may be underidentified in affected females without co-occurring intellectual impairment, owing to a pattern of subtle yet potentially meaningful gender differences in symptom manifestation (e.g., less unusual stereotyped and repetitive behaviors in females, increased prevalence of internalizing problems in females) and gender inequities in research on the ASD phenotype that potentially contributes to biases in assessment tools and diagnostic practices. We offer recommendations for future research directions on gender differences in ASD, and we suggest implications to inform best practice and policy for the assessment of females with ASD.     

From Cases to Capacity? A Critical Reflection on the Role of ‘Ethical Dilemmas’ in the Development of Dual-Use Governance

The dual-use issue is often framed as a series of paralyzing ‘dilemmas’ facing the scientific community as well as institutions which support innovation. While this conceptualization of the dual-use issue can be useful in certain contexts (such as in awareness-raising and as part of educational activities directed at the scientific community) its usefulness is more limited when reflecting on the governance and politics of the dual-use issue. Within this paper, key shortcomings of the dilemma framing are outlined. It is argued that many of the issues raised in the most recent debates about ‘dual-use’ bird flu research remain unresolved. This includes questions about the trajectories of certain lines of research, as well as broader trends in the practice and governance of science. This leads to difficult questions about current approaches to the dual-use issue within the US, as well as internationally.