Prediction of treatment outcomes and longitudinal analysis in children with autism undergoing intensive behavioral intervention

Outcome prediction is an important component of treatment planning and prognosis. However, reliable predictors of intensive behavioral intervention (IBI) have not been clearly established. IBI is an evidence-based approach to the systematic teaching of academic, social, verbal, and daily living skills to individuals with autism spectrum disorder. Incorporating longitudinal analysis to IBI outcome studies may help to identify outcome predictors of clinical value. Twenty-four children with autism underwent on average two years of IBI and completed language, daily living skills, cognitive, and motor assessments (Early Learning Accomplishment Profile and the Learning Accomplishment Profile-Diagnostic, 3rd edition) every six months. We used multilevel analysis to identify potential longitudinal predictors including gender, age, intervention intensity, intervention duration, total intervention time, and pre-intervention functioning. Results indicated that total intervention time, pre-intervention functioning, and age caused the greatest increase in goodness-of-fit of the longitudinal multilevel models. Longitudinal analysis is a promising analytical strategy to identify reliable predictors of the clinical outcome of IBI.     

Relative effects of reduced weight and increased physical activity on hemoglobin A1c: Suggestions for behavioral treatments

Behavioral treatments for diabetes have often been unsuccessful and may benefit from a better understanding of the relative effects of two common treatment foci – decreased weight and increased volume of physical activity – on blood glucose. Overweight and obese adults (N = 59; M_age = 60 years) with hemoglobin A1c (HbA1c) values consistent with diabetes participated in a 6-month community-based behavioral treatment based on tenets of self-efficacy theory and social cognitive theory. The treatment was associated with significantly increased physical activity, reduced body mass index (BMI), and reduced HbA1c levels (ps < .001). Changes in BMI and physical activity accounted for a significant portion of the variance in change in HbA1c, R² = .13, p = .023. Change in volume of physical activity, β = ?.36, p = .007, but not change in BMI, β = ?.03, p = .792, significantly contributed to the variance in HbA1c change that was accounted for. There was no effect based on the sex of participants. Discussion focused on how findings might impact the efficacy, efficiency, and application of behavioral treatments for diabetes management.     

Évolution permanente des outils et procédures de travail au bloc opératoire : la nécessaire formation au travail en équipe en simulation médicale comme réponse organisationnelle

Currently medical and paramedical studies in France are organised separately. Nurses, doctors and specialists are trained separately with specific programs. Organization and public health policy are in permanent evolution. These changes confront caregivers to insecurity during their daily jobs. In this context, interprofessional cooperation is needed. Medical simulation mannequin are used to train caregivers to technical and non-technical activities in safe environment for students as well as for the patients. It allows teachers to analyse the way the students planned, attempted or carried out their actions, and to study the emotional aspects of stressful work in operating room. We will expose the co-construction, use, evaluation and enhancement of such practices in terms of professional team training.     

Motivational enhancement treatment in outpatient addiction centers: A multisite randomized trial

Background/Objectives: Motivational Enhancement Treatment in Spanish (METS) is a brief intervention aimed at resolving patient ambivalence towards behavior change that has demonstrated efficacy in substance use disorder treatment to reduce use and increase treatment engagement in different populations. In order to have evidence for its implementation in Mexico, a multi-site, randomized, two-arm, controlled clinical trial was conducted at three outpatient addiction treatment centers in the country to compare the effect of METS with Counseling as Usual (CAU). Method: One hundred and twenty patients were randomized to receive three sessions of METS (n = 54) or CAU (n = 66) during the first four weeks of treatment and were assessed during the following 12 weeks. Primary outcome measures were self-reported days of substance use and of treatment services utilization, which were tested using Generalized Estimating Equations. Results: Results associated both conditions with significant changes in substance use over, whereas there were no differences between conditions in substance use or in service utilization. Conclusions: Findings do not support the hypothesis that METS is more effective than CAU, but suggest that brief interventions at treatment initiation may improve patient outcomes.     

Collaborative helping maps: a tool to guide thinking and action in family-centered services

This article highlights "disciplined improvisation" as a metaphor for community-based work with multi-stressed families. It introduces Collaborative Helping maps as a tool that both helps workers think their way through complex situations with families and provides a structure to support constructive conversations between workers and families about challenging situations. The article illustrates this map through a clinical vignette and uses interviews with workers to highlight ways in which the map can both enhance worker thinking and support constructive conversations between workers and families about problems that could easily divide them and lead to polarization and escalating tension.     

Developing an outcome-based assessment for family therapy training: the Rochester Objective Structured Clinical Evaluation (ROSCE)

This paper addresses a growing need for cost-effective, outcome-based assessment in family therapy training. We describe the ROSCE, a structured, evidence-informed, learner-centered approach to the assessment of clinical skills developed at the University of Rochester Medical Center. The ROSCE emphasizes direct observation of trainees demonstrating clinical competencies. The format integrates both formative and summative assessment methods. It can readily be adapted to a wide variety of educational and training settings.     

Relationship Education for Incarcerated Adults

As relationship education (RE) programs become more widely implemented, it is important to measure and document the changes associated with RE for diverse audiences. Also, researchers have been challenged to examine the impact of RE with more disadvantaged groups. While we are seeing an increase in this area, only three studies have examined RE with an incarcerated sample. These previous studies examined only those currently in a relationship and focused primarily on couple functioning. The aim of this study was to expand the existing literature by examining RE with a broader sample of incarcerated adults, regardless of current relationship status, and to expand our understanding of its association with outcomes beyond the couple domain by also including measures of individual and parental functioning. In addition, we examined whether change from pre‐ to posttest was moderated by individual characteristics. Using a sample of incarcerated adults (N = 122), the study found positive change in three domains of functioning (couple, individual, and parental). Specifically, results indicated change on five of the eight outcome variables examined. Overall, we found both similarities and differences among program participants on changes from pre‐ to posttest. For the majority of outcomes, the positive change from pre‐ to posttest emerged regardless of individual characteristics.     

New Sexism in Couple Therapy: A Discursive Analysis

The persistence of gender inequality in postindustrial societies is puzzling in light of a plethora of changes that destabilize it, including shifts in economy, legislation, and the proliferation of feminist politics. In family relations, such persistence manifests as a disconnect between couples aspiring to be more egalitarian yet continuing to enact traditional gender roles and hierarchies. There is an emerging consensus that gender inequality persists because of people's continued reliance on sexist ideology or gendered assumptions that constitute women as innately distinct from and inferior to men. Sexist ideology changes its form to accommodate to changing socio‐economic conditions. Contemporary forms of sexism are old ways of legitimizing male power articulated in new and creative ways, often by incorporating feminist arguments. To effectively recognize and address “new sexism,” scholars and practitioners require new, innovative research frameworks. Our objective in writing this article is two‐fold. First, we seek to advance discursive (i.e., focused on language in use) approaches to the study of sexism. Second, we present the results of a discursive analysis of “new” sexist discourse in the context of couple therapy. The study provides preliminary evidence that, despite endorsing egalitarian norms, couples studied continue to rely on gender binaries and remain entrenched in old‐fashioned patterns of gender inequality. Implications of these results for the practice of couple therapy and for future research are discussed.     

A Multi‐Family Group Intervention for Adolescent Depression: The BEST MOOD Program

Depression is the most common mental disorder for young people, and it is associated with educational underachievement, self‐harm, and suicidality. Current psychological therapies for adolescent depression are usually focused only on individual‐level change and often neglect family or contextual influences. The efficacy of interventions may be enhanced with a broader therapeutic focus on family factors such as communication, conflict, support, and cohesion. This article describes a structured multi‐family group approach to the treatment of adolescent depression: Behaviour Exchange Systems Therapy for adolescent depression (BEST MOOD). BEST MOOD is a manualized intervention that is designed to address both individual and family factors in the treatment of adolescent depression. BEST MOOD adopts a family systems approach that also incorporates psychoeducation and elements of attachment theories. The program consists of eight multifamily group therapy sessions delivered over 2 hours per week, where parents attend the first four sessions and young people and siblings join from week 5. The program design is specifically aimed to engage youth who are initially resistant to treatment and to optimize youth and family mental health outcomes. This article presents an overview of the theoretical model, session content, and evaluations to date, and provides a case study to illustrate the approach.     

Mentalizing Family Violence Part 2: Techniques and Interventions

This is the second of two companion papers that provide an overview of mentalization‐based concepts and techniques when working with the seeming “mindlessness” of intra‐family violence. The focus of this paper is on general mentalization‐oriented approaches and specific interventions that aim to (1) disrupt the non‐mentalizing cycles that can generate intra‐family violence and (2) encourage the emergence of patterns of family interactions that provide the foundation for non‐violent alternatives. Various playful exercises and activities are described, including the taking of “mental state snapshots” and “selfies” in sessions and staging inverted role‐plays, as well as using theatrical masks and creating body–mind maps and scans. These can make “chronic” relationship issues come alive in session and permit “here and now” experiences that generate a safe context for mentalizing to take place. At the core of the work is the continuous focus on integrating experience and reflection. Without acute awareness of the thoughts and feelings occurring in the sessions, mere reflection is not likely to enable change. By increasing mentalizing in the family system, family members’ trusting attitudes grow, both within and outside the family.