Predicting Response to an Internet-Delivered Parenting Program for Anxiety in Early Childhood

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3–6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules.     

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.     

养老机构冠心病患者服药依从性现状及影响因素

采用Morisky推荐的MAQ对锦州市养老机构中153名冠心痛患者的服药依从性进行测评,探讨冠心病患者的服药依从性现状及影响因素.结果显示,养老机构冠心病患者服药依从性差的比率为81.7％,影响服药依从性的因素为文化程度、服药种类、医疗背景、入住年限.养老机构的护理人员应对上述因素给予更多的关注,从而提高其服药依从性,进而提升其临床治疗效果.     

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.     

Implementing Group CBT for Depression Among Latinos in a Primary Care Clinic

Depression in low-income Latino populations can be treated using group cognitive behavioral therapy (GCBT). However, effective delivery of GCBT for depression in primary care settings is often impeded by high dropout rates and poor homework adherence. In this study, we describe the structure, processes, and outcomes (including attendance, homework completion, and symptom measures) of GCBT for Spanish-speaking Latino patients with depression in an urban public sector primary care setting. For this study, 96 Latino patients in a primary care clinic participated in at least 1 session of GCBT. Although depressive symptoms among these patients, as measured by the PHQ-9, significantly decreased during treatment, attendance and homework completion were limited. Even with a strategy in place to allow patients to continue in treatment after missing several sessions, 23% of patients dropped out of therapy following their initial session, and approximately half of all patients completed less than 50% (or 8) therapy sessions. Homework was only completed 23% of the time it was checked. Greater session attendance prospectively predicted lower depressive symptoms over time. We discuss potential strategies to increase engagement, treatment effects, and symptom reduction for depression in primary care settings.     

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.     

数学家庭作业动机量表在中国青少年群体中的信效度检验

目的:在中国青少年中对数学家庭作业动机量表进行修订并考察其信效度。方法:采用方便取样选取762名青少年,对数学家庭作业动机量表进行项目分析、探索性因素分析、验证性因素分析、测量等值性检验以及信效度分析。结果:中文版数学家庭作业动机量表包括认同调节、内部动机、外在调节和内摄调节4个因素,并具有跨性别和跨年龄组的测量等值性以及良好的效标效度和信度。结论:修订后的数学家庭作业动机量表具有良好的心理测量学指标,可以作为测量和评估中国青少年数学家庭作业动机的有效工具。     

Parents’ experiences of starting and maintaining exercise: A qualitative systematic review

We conducted a systematic review of qualitative studies investigating the experiences of parents in relation to their uptake and maintenance of exercise, focusing on aerobic endurance-type exercise (e.g., running, cycling, swimming). The review aimed to synthesize qualitative findings relating to the motives, barriers, facilitators, emotions, and support of parents, and to suggest applied implications. Electronic bibliographic databases (Web of Knowledge, Google Scholar, Scopus, Academic Search Complete, and PsychArticles) were searched with relevant keywords to identify published peer-reviewed journal articles. Articles were included if they used a qualitative methodology to collect and analyse the data, and if they involved parents (of at least one child up to age 18) engaging in one or more type of aerobic endurance-type exercise from a position of limited fitness and parenthood. Ten studies were included in the final review, which used a narrative synthesis of data. Findings unique to the parent population were identified: parents were motivated to exercise as they believed it made them a better parent; mothers found it difficult overcoming the ‘ethic of care’; both mothers and fathers experienced the emotion of guilt, although its impact differed between parent roles; parenthood was associated with low confidence; and parents reported a lack of social support and self-regulatory capacity. These findings also reflect wider social determinants of health, in their racialized, gendered, and classed nature. To support parents in maintaining exercise uptake, the findings suggest that practitioners should promote reasons for exercise that align with parents’ core values to facilitate autonomous motivation.     

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.