Learning from parents' stories about what works in early intervention

Using a multiple case study approach, this ethnography examined the experiences of parents of children deemed at risk for developmental delays or disabilities who had received early intervention (EI) services (birth to age 3 years) in a large urban location in Western Canada. Participants (11 adult parents and 7 children) were drawn from six families. Methods of data collection included focus groups (FG), face‐to‐face interviews and file reviews. Member check and expert reviews were conducted throughout data collection and data analyses as part of the validation process in this ethnography. Qualitative content analyses followed by thematic analyses highlighted the implementation of family‐centred practices (FCP) as a main theme. Parents identified how EI professionals using FCP embraced collaborative practices. FCP resulted in parents leading the EI process for their children. More specifically, EI professionals shared strategies and information to support parents in gaining a deeper understanding of their children's individual developmental characteristics. Parents expressed how empowering this level of understanding was for them as they learned to articulate what were their children's needs for developmental, health and educational services. Recommendations for future research include inquiring about parents' experiences for families of diverse constellations and/or residing in smaller urban or rural communities.     

Collaborative Measurement Development as a Tool in CBPR: Measurement Development and Adaptation within the Cultures of Communities

This paper describes the processes we engaged into develop a measurement protocol used to assess the outcomes in a community based suicide and alcohol abuse prevention project with two Alaska Native communities. While the literature on community-based participatory research (CBPR) is substantial regarding the importance of collaborations, few studies have reported on this collaboration in the process of developing measures to assess CBPR projects. We first tell a story of the processes around the standard issues of doing cross-cultural work on measurement development related to areas of equivalence. A second story is provided that highlights how community differences within the same cultural group can affect both the process and content of culturally relevant measurement selection, adaptation, and development.     

Preterm infants’ orally directed behaviors and behavioral state responses to the integrated H-HOPE intervention

Preterm infants are challenged by immature infant behavioral organization which may negatively influence their ability to oral feed. The purpose of this study was to determine whether the integrated H-HOPE (Hospital to Home: Optimizing the Infant's Environment) intervention would improve infant behavioral organization by increasing the frequency of orally directed behaviors and the proportion of time spent in an alert behavioral state when offered prior to oral feeding. Mother–infant dyads (n = 198) were randomly assigned to the H-HOPE intervention or the Attention Control groups. Infants were born at 29–34 weeks gestation and were clinically stable. Mothers had at least two social environmental risk factors such as minority status or less than high school education. H-HOPE is an integrated intervention that included (1) twice-daily infant directed stimulation using the ATVV intervention (auditory, tactile, visual, and vestibular stimuli) and (2) maternal participatory guidance sessions by a nurse-community advocate team. Orally directed behaviors and behavioral states were assessed weekly prior to feeding during hospitalization when infants were able to feed orally. There were no differences between the groups at baseline (Day 0, prior to the initiation of the integrated H-HOPE intervention). We observed a pattern of increased frequency of orally directed behaviors in the H-HOPE intervention group when compared to the Attention Control group, however, the proportion of time spent in an alert behavioral state remained stable in both groups over the course of the study. On Day 7, the H-HOPE intervention group exhibited a significantly higher mean frequency of orally directed behaviors than the Attention Control group (12.6 vs. 7.1 pre-intervention, 51.8 vs. 33.2 during intervention, 4.3 vs. 3.2 immediately after intervention, and 8.9 vs. 5.3 immediately prior to feeding). On Day 7, the H-HOPE intervention group exhibited a significantly higher proportion of time spent in an alert behavioral state only during intervention (0.26 vs. 0.11) and immediately after intervention (0.28 vs. 0.06). These findings are suggestive that the integrated H-HOPE intervention facilitated infant behavioral organization for clinically stable infants born between 29 and 34 weeks gestation. The orally directed behaviors appear to be an important indicator of the infant's preparation for feeding, and when used in conjunction with assessment of behavioral states, are especially valuable to the clinician. Use of this combined assessment approach in practice would strengthen clinician assessment for initiation of (beginning the first oral feeding) and daily preparation for oral feeding in preterm infants.     

Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother–infant relationship

Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory–tactile–visual–vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother–infant relationship compared to an attention control group.240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 g for ATVV, 1022 for KC, and 1023 for control).Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-min videotapes of mother–infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability.Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal distress variable. Kangaroo care mothers showed a more rapid decline in worry than the other mothers. The only interactive dimensions that differed between the groups were child social behaviors and developmental maturity, which were both higher for kangaroo care infants. Change over time in several individual infant behaviors was affected by the interventions. When mothers reported on the interventions they performed, regardless of group assignment, massage (any form including ATVV) was associated with a more rapid decline in depressive symptoms and higher HOME scores. Performing either intervention was associated with lower parenting stress. These findings suggest that as short-term interventions, KC and ATVV have important effects on mothers and their preterm infants, especially in the first half of the first year.     

Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism

This study tested the effects of a parent-mediated intervention on parental responsiveness with their toddlers at high risk for an autism spectrum disorder (ASD).Participants included caregivers and their 66 toddlers at high risk for ASD. Caregivers were randomized to 12 sessions of an individualized parent education intervention aimed at improving parental responsiveness or to a monitoring control group involving 4 sessions of behavioral support. Parental responsiveness and child outcomes were measured at three time points: at beginning and end of the 3-month treatment and at 12-months post-study entry. Parental responsiveness improved significantly in the treatment group but not the control group. However, parental responsiveness was not fully maintained at follow up. There were no treatment effects on child outcomes of joint attention or language. Children in both groups made significant developmental gains in cognition and language skills over one year. These results support parental responsiveness as an important intervention target given its general association with child outcomes in the extant literature; however, additional supports are likely needed to fully maintain the treatment effect and to affect child outcomes.     

PCI术前术后的心理障碍识别与处理

概述冠心病经皮冠状动脉介入治疗（PCI）术前术后患者合并心理障碍的较高发生率以及心理障碍对冠心病发生、发展及预后的影响,分析 PCI 术前术后患者出现焦虑抑郁等心理障碍的原因、产生机制及影响因素,强调心内科医生应及时识别 PCI 术前术后患者出现的心理障碍,并以“双心医学”方式对其进行心理精神医学及心血管专科医学治疗,同时对心血管专科医学治疗效果不明显的冠心病 PCI 患者,进行相关的鉴别诊断后也要进行心理精神医学的诊断和治疗,以便有利于 PCI 术患者的康复和预后,减少不必要的检查和治疗。     

Understanding the context of suicide in master's level counselling programmes in Australia

The purpose of this study was to understand the context of suicide in master's level counselling courses in Australia. The sample comprised courses accredited by the Australian Counselling Association (ACA) and the Psychotherapy and Counselling Federation of Australia (PACFA). A mixed methods content analysis was used to identify the explicitness of suicide in these courses and identify themes that emerged during the analysis. The sample consisted of 405 units of study contained in 26 courses. Suicide was explicit in 23 units in 17 courses. Suicide content was overshadowed by cultural diversity, ethics, morality and philosophy, research and self-awareness, which was explicit in all 26 courses.     

Sustainable antibullying program implementation: School profiles and predictors

We examined the sustainability of the KiVa antibullying program in Finland from its nationwide roll-out in 2009 to 2016. Using latent class analyses, we identified four different patterns of implementation. The persistent schools (43%) maintained a high likelihood of participation throughout the study period. The awakened (14%) had a decreasing trend during the first years, but then increased the likelihood of program participation. The tail-offs (20%) decreased in the likelihood of participating after the third year, and the drop-offs (23%) already after the first year. The findings suggest that many schools need support during the initial years to launch and maintain the implementation of evidence-based programs; yet a large proportion of schools manage to sustain the program implementation for several years. The logistic regression analyses showed that large schools persisted more likely than small schools. Lower initial level of victimization was also related to the sustainability of the program. Finally, persistent program participation was predicted by several school-level actions during the initial years of implementing the program. These results imply that the sustainability of evidence-based programs could be enhanced by supporting and guiding schools when setting up the program during the initial implementation.