The Role of Fidelity and Feedback in the Wraparound Approach

Wraparound approaches are being implemented with children in many mental health systems around the country. Evidence for the effectiveness of the wraparound approach, however, is limited. In addition, the degree to which wraparound interventions adhere to the principles of wraparound has rarely been assessed. We examined the influence of adherence to wraparound principles and outcome feedback within the wraparound approach. Children participating in family team meetings were enrolled in a feedback or no feedback condition. Teams receiving feedback were given a brief report regarding outcome progress four times over a three-month period. In addition, adherence to wraparound principles was assessed in the initial team meeting and examined in relationship to outcome at three months and nine months. Although youth in both feedback and non-feedback groups improved with intervention, there were few differences between the groups based on outcome feedback. Similarly, adherence was uniformly high and did not influence the outcome for individual cases. Although the wraparound approach was helpful for youth in our sample, outcome feedback and adherence to wraparound principles had limited influence on these effects.     

Beyond the therapeutic hour: an exploratory pilot study of using technology to enhance alliance and engagement within face-to-face psychotherapy

In this paper we introduce and investigate the capacity for a novel, technologically advanced system (goACT) to enhance face-to-face psychotherapy. Specifically, we explore the capacity for goACT to enhance therapeutic alliance (TA) and engagement, and reduce distress. Using a mixed-methods, multiple-baseline design we present the first study to examine the utility, effectiveness and user experience of goACT in a university psychology clinic setting. The introduction of between-session goACT use was staggered across patients (N = 7). Patients completed weekly measures of mood, patient-rated TA and clinician-rated engagement. Semi-structured interviews were used to qualitatively understand user experience of the system. Methodological limitations impacted the generalisability of multiple-baseline findings, yet qualitative results provide a significant contribution to the literature and groundwork upon which further study can be built. Results indicated that goACT built engagement and TA via novel change processes that were associated with expanding the parameters of the therapeutic encounter beyond the one-hour session. Change processes that underpin the qualitative success of goACT are discussed in terms of their theoretical implications. goACT is likely to be a useful tool for enhancing the quality and quantity of traditional face-to-face psychotherapy.     

Effects of lifestyles and the Mediterranean diet on elderly people’s quality of life according to gender / Efectos de los estilos de vida y la dieta mediterránea en la calidad de vida en personas mayores en función del género

Abstract

Health-related quality of life (HRQoL) has been associated with certain eating habits, such as the Mediterranean diet (MD) and lifestyles. However, the specific role of gender in this association is not yet known. The objective of this study was to analyse the relationship between the consumption of the MD essential foods and lifestyle (tobacco and alcohol consumption and exercise) with the HRQoL of 340 elderly people aged over 60 living in the Spanish Mediterranean area. The results show a better HRQoL in males. Compared to females, the lifestyles of males include a moderate consumption of alcohol and tobacco in addition to a greater frequency of physical activity. The predictive models of HRQoL were also different between males and females, as the influence of lifestyles and MD were greater in males. These results are clinically useful for the designing of programmes that promote successful ageing as they can be specified for sex.     

Factors Predicting Attrition Within a Community Initiated System of Care

We designed this study to elucidate child, family, and service level characteristics that may influence attrition from a continuum of care developed and maintained by a community initiated collaboration of local clinics and agencies. Subjects included 117 children and adolescents referred to the Middlesex County system of care from 1992–1999. Data were collected through a retrospective case review. The strongest predictors of attrition from the system of care both before and after the establishment of an individualized service plan included depressed/isolated symptoms, substance abuse, general risk for psychiatric problems, number of referral reasons and urgency status at program intake. Among youth exiting residential placement, those completing recommended services were more likely to be returned home earlier or within the expected time frame than were dropouts. Our study presents important preliminary findings regarding characteristics related to treatment adherence within a community initiated systems of care.     

Religious Beliefs,Diet, and Physical Activity Among Jewish Adolescents

Despite a well‐documented connection between religion and mortality, the link between religion and obesity‐related outcomes and behaviors has not been adequately studied, particularly among adolescents. This study examines whether self‐reported religious beliefs influence decisions about physical activity and diet in a sample of Jewish adolescents (n = 351). The results show that reporting a stronger influence of religious beliefs on health behaviors is associated with behaviors related to physical activity, but not diet. In adjusted regression models, individuals who report that their religious beliefs influence decisions about being physically active “a lot” have significantly more active days per week than those who say their religious beliefs do not influence such decisions. Similar effects are seen with regard to the students’ overall amount of sedentary time. The results shed light on previously documented relationships between religion and health, provide practical implications for religious organizations and leaders, and suggest areas for future research.     

Person‐Centred and Experiential Psychotherapy Scale: Development and reliability of an adherence/competence measure for person‐centred and experiential psychotherapies

Aims: This study aimed to assess the reliability of the Person‐Centred and Experiential Psychotherapy Scale (PCEPS), a new adherence/competence measure of person‐centred and experiential psychotherapies. The PCEPS consists of 15 items with two subscales: Person-Centred Process and Experiential Process. Method: One‐hundred twenty audio‐recorded segments of therapy sessions were rated independently by two teams of three raters using the PCEPS. Half of the segments were 10 minutes long and the other half were 15 minutes long. Six therapists were experienced therapists and four were counsellors in training. Seven of the therapists identified their work as ‘person‐centred’, and three identified their work as ‘process‐experiential’. Three raters were qualified and experienced person‐centred therapists and three raters were person‐centred counselling trainees in their first year of training. Results: Interrater reliabilities were good (alpha: .68–.86), especially when ratings were averaged across items (alpha: .87); interitem reliabilities were quite high (alpha: .98). Exploratory factor analyses revealed a 12‐item facilitative relationship factor that cuts across Person‐Centred and Experiential subscales (alpha: .98), and a nonfacilitative directiveness factor (3 items, alpha: .89). Conclusions/Implications: The PCEPS has potential for use in RCT research as well as in counselling training and supervision, but will require further testing and validation.     

Parents As Teachers:

A follow-up mail survey of the continuing use of behavior modification procedures was conducted with 30 families who had participated in a training program for parents of preschool children with autism four to seven years previously. According to their reports 86% of the parents had used behavioral procedures during the past week to manage their child's behavior and 54% said they used the techniques to teach their child a new skill. More than half of the parties said they no longer used “formal” behavior modification procedures including data collection. Mothers were more likely to use formal behavior modification than father and systematic paternal use of behavioral techniques was linked to maternal use- only one father used the techniques including data collection when his wife did not. Retrospective parental evaluations of the parent training workshop were all positive, although the parents who viewed their children as doing better gave stronger endorsements than the parents who say their children as more limited.     

Contextual Intervention for Caregiver Non-Adherence With Behavioral Intervention Plans

The extent to which parents and other caregivers implement behavioral interventions with integrity has an important impact on treatment effectiveness. This article considers popular interventions that train caregivers and improve treatment integrity in applied behavior analysis. After considering these interventions a contextual approach is described, whereby the function of caregiver non-adherence is considered. In particular, interventions aimed at manipulating setting factors are reviewed. The examples of respite and social support groups are provided as function-based interventions to improve caregiver adherence to behavioral recommendations. Implications for more contextual, coordinated, and comprehensive function-based behavioral services are provided.     

State gratitude for one’s life and health after an acute coronary syndrome: Prospective associations with physical activity,medical adherence and re-hospitalizations

Abstract

Gratitude may be associated with beneficial health outcomes, but studies of this association have been mixed, and in these studies gratitude has often been conceptualized as a stable, unidimensional trait. We used four specific items to examine the prospective association of state- and domain-specific gratitude with medical outcomes among 152 patients with a recent acute coronary syndrome. State gratitude for one’s health 2 weeks post-event was associated with increased physical activity (measured via accelerometer) 6 months later, controlling for relevant demographic, social, medical and psychological factors (β = 340.9; 95% confidence interval = 53.4–628.4; p = .020). Gratitude for one’s life was associated with increased self-reported medical adherence at 6 months on the maximally adjusted model (β = .60; 95% confidence interval = .16–1.04; p = .008); no gratitude items were associated with rehospitalizations. In contrast, dispositional gratitude, measured by the Gratitude Questionnaire-6, was less dynamic and responsive to change over the 6-month period and was not associated with physical activity.     

Cross-cultural perspectives on coping with the risks of maternal phenylketonuria

Abstract

Maternal phenylketonuria (PKU) refers to the deleterious effects on a fetus due to high maternal phenylalanine levels. Prevention of these effects requires that women with PKU reduce their blood phenylalanine levels prior to and throughout pregnancy which means that they plan their regnancies and adhere to a phenylalanine restricted diet. According to a psycho-social model of maternal PKU, a first necessary step in preventing the effects of maternal PKU is prevention of unplanned pregnancies i.e.: using effective family planning practices. In the present study, findings are presented on seventy-five phenylketonuric women (60 from the United States and 15 from Israel) who participate in a prospective longitudinal study, to reveal the reasons why the proportion of pregnancies treated prior to conception has consistently been higher in Israel than in the United States. The two groups were interviewed and administered a battery of tests and questionnaires measuring a wide range of variables associated with family planning. Subjects in the United States were found to have more knowledge about fertility, contraception and maternal PKU. Israeli subjects held more negative attitudes towards and were less engaged in premarital sexual relationships, more frequently used oral contraceptives, had stronger motivation to have their own children, and perceived their disease to have a more negative effect on their lives. These findings suggest that the issues in maternal PKU are cultural as well as medical and psychosocial.