Intensive specialised multi-family therapy for multi-stressed families: Therapeutic alliance as predictor for effectiveness

The effectiveness of intense specialised multi-family therapy (ISMFT) for 111 multi-stressed families, and the therapeutic alliance as a possible predictor of outcome, were examined. A repeated measures design was used, where changes in all ISMFT phases (preparation, multi-family therapy and follow-up) were assessed and compared for both mothers and fathers. Evidence was found for improved family functioning after the therapy period, which was maintained at 3 months follow-up, although the multi-stressed families still functioned in the problematic range. The therapy did however not decrease parenting stress, or did so only temporarily. Observations of the therapeutic alliance with the System for Observing Family Therapy Alliances (SOFTA) scales indicated that high therapist engagement was related to positive therapy outcomes, both at the start of therapy and later. High family engagement also predicted therapy effectiveness, but only at the start of therapy. The present study shows that solution-focused multi-family therapy at least seems to provide the first step in alleviating problems in multi-stressed families.     

Barriers and Facilitators to the Implementation of Intensive Treatments for PTSD: Early Lessons Learned From the Field

This article addresses the barriers and facilitators associated with the implementation of PTSD Intensive Outpatient Programs (IOP) across three VHA Medical Centers. Each site developed programs that delivered EBPs in a massed or condensed format and relied on implementation science and the i-PARIHS model to help direct the innovation. Face-to-face, virtual, and combined platforms were used, demonstrating flexibility in design. While each site experienced unique challenges associated with local contextual factors, multiple themes emerged across sites that may help guide future IOP and massed EBP implementations. Common facilitators of the implementation process included: the availability or presence of a credible lead (i.e., champion) to guide the innovation, opportunities to consult with national or outside experts, strong team engagement, processes in place that allowed for ongoing review, clinic operations that are aligned with principles of PTSD specialty care (e.g., time-limited, evidence-based, utilization of measurement based care, willingness to treat complex cases), and leadership support. Alternately, shared barriers included limitations on available resources, options for provider coverage, early staff buy-in, and organizational factors. Solutions to address these barriers and recommendations for future direction are shared.     

Using tenets from the Bhagavad Gita in counselling diaspora Hindu older adults: Impact on stress mitigation and improving quality of life

This article reports a study on the impact of a Bhagavad Gita (BG) text-based counselling programme for long-term immigrant diaspora Hindu older adults in the US and UK. Compared with the journal writing sessions, participants of the BG lessons reported lower stress and better quality of life post-test (p ≤ 0.025; Hedges' g = −0.65–0.36). Results of the latent class analyses highlighted complex behaviour patterns in the post-test dataset and foregrounded six classes/subgroups of participants likely to gain most from the BG programme: older adult females, diaspora Hindu older adults with postgraduate-professional qualifications, widowed older adults, those living alone or with other kith-kin, those with above threshold programme compliance (defined as those who attended 13–24 (>50%) BG lessons, and completed 13–24 (>50%) BG homework lessons). Overall, the results of the study endorse the connection between age and religiosity and support a BG text-based counselling programme as a workable strategy for long-term immigrant diaspora Hindu older adults. The BG text provides a firm ethnoculturally grounded counselling approach to work with diaspora Hindu older adult clients, taking cognisance of their intersectional realities. It may help them cope with the dynamics of the modern, traditional, and continuously shifting realities in a foreign milieu.     

Examining Influences on Problem Recognition and Help-Seeking for Child Externalizing Behaviors Among African American Mothers

Childhood behavior problems are one of the most common clinical referrals. If left untreated, these behaviors can result in detrimental consequences to the child’s development (Wehmeier et al., 2010; Scholtens et al., 2012). Behavior parent training has been identified as first-line treatment for oppositional behavior; however, many racial minority families fail to enroll in behavior parent training. The current study examines maternal help-seeking for children displaying oppositional behavior in hopes to delineate variables that might influence parent training enrollment among African American families. Participants were 112 African American mothers who were provided child behavior vignettes and completed measures assessing factors related to problem recognition, parental attributions, child rearing values, mental health stigmatization, racial identity, and treatment utilization. Results found that when presented with a child displaying clinically significant externalizing child behaviors, slightly more than half of African American mothers recognized clinically significant child behavior problems. Mothers were more likely to engage in behavioral parent training if problematic behavior was recognized. Additionally, mothers’ attributions of child behavior, cultural values, and mental health stigmatization were influential to help seeking. This study supports the importance of considering cultural variables that impact problem recognition and subsequent treatment utilization among African American families.     

The sociodemographic and psychosocial correlates of COVID-19 vaccine concerns among urban college students

COVID-19 vaccine concerns remain high among Americans. Although recent studies have investigated the sociodemographic disparities in vaccine concerns, less attention has been given to reasons for vaccine skepticism and psychosocial factors that may explain it. The current study examined specific types of vaccine concerns among a diverse sample of college students (N = 1985) living in New York City. Participants who identified as Black, younger, with later immigrant generational status, and those with more conservative political leanings reported more vaccine concerns. Concerns regarding vaccine side effects were the most frequently reported source of concern. Reason for getting vaccinated, personal experiences with COVID, and COVID stress was also associated with vaccine concerns. Study results emphasize the importance of sociodemographic factors and COVID knowledge and stress in examining and addressing vaccine concerns.     

Differences in the importance of romantic structures among transgender and cisgender adults during the COVID-19 pandemic

The stressors of the global COVID-19 pandemic have led to an increased need for support. For adults, romantic relationships often represent an environment of emotional support and stability; as such, attitudes toward—and particularly the importance of—romantic relationships may have shifted as a result of the pandemic. The present cross-sectional study explores how U.S. transgender (n = 99) and cisgender people (n = 1886) report whether they have perceived a change in their feelings about the importance of long-term romantic structures (i.e., committed relationships, monogamy, cohabiting with a romantic partner, and marriage) as a result of the COVID-19 pandemic. Results found that transgender people reported a more positive perceived change in importance placed on all four romantic items relative to cisgender people. Different forms of stress (e.g., social, financial, health) associated with the COVID-19 pandemic may have contributed to an increased need, and subsequent desire, for social connection and support in the form of romantic relationships among transgender individuals to a greater extent than cisgender individuals, perhaps in part due to the additional layers of stress transgender people must navigate. Results are discussed through the lens of the minority stress framework.     

Coping with COVID: Use,factor structure,and health behavior implications of specific emotion regulation strategies during the coronavirus pandemic

This series of studies examined U.S. individuals' use of specific emotion regulation/coping strategies during the early months of the COVID-19 pandemic, investigated the factor structure among strategies during this universally experienced stressor, and the extent to which these factors predicted engagement in COVID-related health-promoting behaviors. In Study 1, participants (N = 520) rated their use of 17 strategies for coping with pandemic-related stress during the past 24 h. Differences emerged in strategy use across demographic groups (age, race, income). Results of exploratory factor analysis suggest a factor structure grouping strategies in terms of goals beyond emotion regulation per se, rather than phases of the emotion process or a binary adaptive versus maladaptive distinction. In Study 2 (N = 264), participants reported daily on their coping strategy use and weekly on their engagement in COVID-specific health behaviors for 22 days. Results of confirmatory factor analysis replicate the factor structure found in Study 1. Some significant associations of coping strategy use with health-promoting behaviors were observed, but these were sporadic and largely involved baseline measures rather than predicting change over time. Theoretical and practical implications are discussed.     

Parental assessment of the adjustment of children following abduction by the other parent

We present a multiple regression model that explores post-return adjustment of school-age children who experienced abduction by a parent. The model includes: a) child and family characteristics preceding abduction, b) characteristics of the abduction experience, and c) child and family characteristics following return. Overall, the model accounts for 21% of the variance in post-return adjustment of children (p.05). The most salient finding is that post-return adjustment of children was best explained by characteristics of the child and family before the abduction occurred. Domestic violence perpetrated by one or both parents was the most significant factor.     

The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressive and coercive behaviors are exhibited by both patients and staff.