The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis.

BACKGROUND: Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES: To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN: For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS: Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS: Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES: Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS: Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS: We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS: It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS: Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK: Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION: This study is registered as PROSPERO CRD42013003889. FUNDING: The National Institute for Health Research Health Technology Assessment programme

Impacto de un programa intervención em alunos del segundo ciclo

O objetivo do presente estudo consistiuem avaliar um programa de intervenção junto a alunos do 2º ciclo de escolaridade nas seguintes dimensões: tomada de decisão, conhecimentos sobre sexualidade, competências sociais, assertividade e autoconceito. Metodologia: Participaram 145 alunos, distribuídos pelos grupos controle e experimental. Os instrumentos utilizados foram: TCU Decision-Making; Questionário de Conhecimentos sobre Sexualidade; Assertion Self-Statement Test- Revised; Questionário de Competências Sociais; Piers-Harris Children’s Self-Concept Scale. Os resultados revelaram diferenças no pós-teste entre os grupos ao nível da sexualidade. Verificaram-se diferenças do pré-teste para o pós-teste no grupo experimental nos níveis da sexualidade, da assertividade e das competências sociais. No grupo experimental encontraram-se associações positivas entre tomada de decisão, competências sociais e assertividade, bem como entre sexualidade, competências sociais e autoconceito, no pós-teste. Os preditores da assertividade no pós-teste foram tomada de decisão, sexualidade e competências sociais. Como conclusão, os resultados enfatizam a importância de intervenção junto a adolescentes, particularmente na tomada de decisão, na sexualidade e nas competências sociais. Palavras-chave: Habilidades sociais, sexualidade, autoconceito.In this study we evaluate an intervention program in the following dimensions: Decision Making, Knowledge on Sexuality, Social Skills, Assertiveness and Self-Concept with students in 5th and 6th grade. Methodology: 145 students participated in the study divided by control and experimental group. The instruments used were: Decision-Making TCU, Knowledge on Sexuality Questionnaire; Assertion Self-Statement Test-Revised;Social Skills Questionnaire, and Piers-Harris Children's Self- Concept Scale. The results indicate differences at post-test between the groups on knowledge regarding sexuality. There were also differences from pre-test to post-test in the experimental group on knowledge on sexuality, assertiveness and social skills. Positive associations among decision making, social skills and assertiveness were found as well as among knowledge on sexuality, social skills and self-concept, in the experimental group, in the pos-test. Finally, the predictors of assertiveness regarding health behaviors, in the pos-test were: decision making, knowledge regarding sexuality and social skills. The results emphasize the importance of intervention for adolescents in terms of health promotion particularly in decision making, sexuality and social skills.El objetivo del presente estudio fue evaluar un programa de intervención con alumnos del 2º ciclo de escolaridad en las siguientes dimensiones: Toma de Decisión, Conocimientos sobre Sexualidad, Habilidades Sociales, Asertividad y Autoconcepto. Metodología: Participaron 145 alumnos, distribuidos en grupo control y experimental. Los instrumentos utilizados fueron: TCU Decision-Making; Cuestionario de Conocimientos sobre Sexualidad; AssertionSelf-Statement Test-Revised; Cuestionario de Habilidades Sociais; Piers-Harris Children'sSelf-Concept Scale. Los resultados mostraron diferencias en el post-test entre los grupos en cuanto a la sexualidad. Se verificaron diferencias del pre-test para el post-teste en el grupo experimental, cuanto a sexualidad, asertividad y habilidades sociales. Se encontraron asociaciones positivas entre toma de decisión, habilidades sociales y asertividad, así como entre sexualidad,habilidades sociales yautoconcepto, en el post-test en el grupo experimental. Los predictores de la asertividad en el post-test fueron toma de decisión, sexualidad y habilidades sociales. Los resultados destacan la importancia de la intervención con adolescentes particularmente en la toma de decisiones, sexualidad y habilidades sociales.(undefined

Evaluating the Psychometric Quality of Social Skills Measures: A Systematic Review

Introduction - Impairments in social functioning are associated with an array of adverse outcomes. Social skills measures are commonly used by health professionals to assess and plan the treatment of social skills difficulties. There is a need to comprehensively evaluate the quality of psychometric properties reported across these measures to guide assessment and treatment planning. Objective - To conduct a systematic review of the literature on the psychometric properties of social skills and behaviours measures for both children and adults. Methods - A systematic search was performed using four electronic databases: CINAHL, PsycINFO, Embase and Pubmed; the Health and Psychosocial Instruments database; and grey literature using PsycExtra and Google Scholar. The psychometric properties of the social skills measures were evaluated against the COSMIN taxonomy of measurement properties using pre-set psychometric criteria. Results - Thirty-Six studies and nine manuals were included to assess the psychometric properties of thirteen social skills measures that met the inclusion criteria. Most measures obtained excellent overall methodological quality scores for internal consistency and reliability. However, eight measures did not report measurement error, nine measures did not report cross-cultural validity and eleven measures did not report criterion validity. Conclusions - The overall quality of the psychometric properties of most measures was satisfactory. The SSBS-2, HCSBS and PKBS-2 were the three measures with the most robust evidence of sound psychometric quality in at least seven of the eight psychometric properties that were appraised. A universal working definition of social functioning as an overarching construct is recommended. There is a need for ongoing research in the area of the psychometric properties of social skills and behaviours instruments

Longevity Around the Turn of the 20th Century: Life-Long Sustained Survival Advantage for Parents of Today’s Nonagenarians

Members of longevous families live longer than individuals from similar birth cohorts and delay/escape age related diseases. Insight into this familial component of longevity can provide important knowledge about mechanisms protecting against age-related diseases. This familial component of longevity was studied in the Leiden Longevity Study which consists of 944 longevous siblings (participants), their parents (N=842), siblings (N=2302), and spouses (N=809). Family longevity scores were estimated to explore whether human longevity is transmitted preferentially through the maternal or paternal line. Standardized mortality ratio’s (SMRs) were estimated to investigate whether longevous siblings have a survival advantage compared to longevous singletons and we investigated if parents of longevous siblings harbor a life-long sustained survival advantage compared to the general Dutch population by estimating lifetime SMRs (L-SMRs). We found that sibships with long-lived mothers and non-long-lived fathers had 0.41 (P=0.024) less observed deaths than sibships with long-lived fathers and non-long-lived mothers and 0.48 (P=0.008) less observed deaths than sibships with both parents non-long lived. Participants had 18.6% less deaths compared to matched singletons and parents had a life-long sustained survival advantage (L-SMR=0.510 and 0.688). In conclusion, genetic longevity studies may incorporate the maternal transmission pattern and genes influencing the entire life-course of individuals

Concordance Between Clinicians' and Patients' Ratings of Anxiety and Depression as Mediated by Private Self-Consciousness

This study assesses the relations between the ratings of clinicians and psychiatric inpatients on several anxiety and depression measures, as mediated by private selfconsciousness. The overall concordance between clinicians' and patients' ratings is quite high, particularly on the depression measures. Levels of private selfconsciousness do not appear to mediate concordance of structured behavior or symptom-based ratings of either anxiety or depression; however, there is limited support for levels of private self-consciousness mediating concordance between patients' global ratings of anxiety and clinicians' anxiety ratings

The Relationship Between Clinicians' And Patients' Ratings Of Anxiety And Depression As Mediated By Self-Consciousness

The purpose of the present study was to assess the accuracy of self-reports of anxiety and depression, as mediated by self-consciousness, for a psychiatric inpatient population. The accuracy of the self-reports was determined by examining the concordance between the ratings of the patients and of two clinicians on several anxiety and depression measures. It was predicted that subjects high in private self-consciousness would be more accurate self-reporters than would those low in private self-consciousness, and that levels of public self-consciousness would have no bearing on the relationship between self-reports and clinicians' judgments.Contrary to prediction, the vast majority of the correlations between the patient's and the clinicians' ratings did not differ significantly for high vs. low private self-consciousness patients; however, the high privates did achieve significantly higher concordance rates than low privates when they utilized a "global" measure of anxiety. In contrast, the low privates achieved unexpectedly higher concordance rates than high privates when they used a very structured, symptom-specific self-report measure of depression. As for public self-consciousness, no difference was found in the correspondence between self-reports and clinicians' ratings of anxiety for high vs. low publics; however, when using a symptom-specific self-report measure of depression, low publics achieved higher concordance rates than did the high publics. These results were discussed in terms of (1) the nature of the self-report measures utilized and of the constructs they assessed, and (2) the differential diagnoses of the high and low private patients and of the high and low public patients.The surprisingly high correlations between the patients' and clinicians' ratings for the entire inpatient sample were likely a function of: the highly reliable and valid self-report inventories and clinical rating scales utilized; the structured, symptom-focused, and goal-directed clinical interviews conducted; and the rapport and trust established between the patients and the clinicians.</p

My Bun In Her Oven: Ethics, Exploitation, and Dharma in India\u27s Surrogacy Industry

This bioethics thesis concerns some of the ethical issues surrounding the transnational gestational surrogacy industry between the United States and India. Facilitated by the Internet, a demand for genetically related children, political factors, and widespread poverty, India has become a popular destination for parents seeking children born through surrogates. This research primarily analyzes existing philosophical literature, but it was informed by a set of interviews conducted in India during the summer of 2014. In this research project, I address some of the issues with previous research done on surrogacy, as a substantial portion of this research focuses only on surrogacy in the Global North and promotes certain themes and narratives that are, from a feminist perspective, undesirable. Some of the interviews revealed consistent themes, including the concepts of majboori and dharma. These ideas come from Hindu theology, and will be explored in depth. I ask whether surrogacy in India is exploitative by analyzing various conceptions of Marxian exploitation, and find that there is no single definition of exploitation that perfectly applies to surrogacy. Further, I ask if there are other philosophical issues that should be cause for worry, including coercion, objectification, neocolonialism, and market expansionism. Overall, the research shows that surrogacy has some aspects of exploitation, but does not neatly fit any existing definitions of exploitation. Surrogacy involves a necessary level of objectification, though it is not coercive. Market expansionism and promotion of narratives are serious concerns that should not be taken lightly, though neither is sufficient to justify banning surrogacy. However, recognizing surrogate mothers’ work as “legitimate labor” will lend value to the idea of “women’s work.” This thesis was motivated by a worry about what should be done regarding surrogacy. Ultimately, I find that surrogacy has some aspects that ought worry us philosophically, though those aspects ought not stop us from recognizing surrogacy, socially and legally, as a legitimate form of labor

The Relationship Between Clinicians\u27 And Patients\u27 Ratings Of Anxiety And Depression As Mediated By Self-Consciousness

The purpose of the present study was to assess the accuracy of self-reports of anxiety and depression, as mediated by self-consciousness, for a psychiatric inpatient population. The accuracy of the self-reports was determined by examining the concordance between the ratings of the patients and of two clinicians on several anxiety and depression measures. It was predicted that subjects high in private self-consciousness would be more accurate self-reporters than would those low in private self-consciousness, and that levels of public self-consciousness would have no bearing on the relationship between self-reports and clinicians\u27 judgments.Contrary to prediction, the vast majority of the correlations between the patient\u27s and the clinicians\u27 ratings did not differ significantly for high vs. low private self-consciousness patients; however, the high privates did achieve significantly higher concordance rates than low privates when they utilized a global measure of anxiety. In contrast, the low privates achieved unexpectedly higher concordance rates than high privates when they used a very structured, symptom-specific self-report measure of depression. As for public self-consciousness, no difference was found in the correspondence between self-reports and clinicians\u27 ratings of anxiety for high vs. low publics; however, when using a symptom-specific self-report measure of depression, low publics achieved higher concordance rates than did the high publics. These results were discussed in terms of (1) the nature of the self-report measures utilized and of the constructs they assessed, and (2) the differential diagnoses of the high and low private patients and of the high and low public patients.The surprisingly high correlations between the patients\u27 and clinicians\u27 ratings for the entire inpatient sample were likely a function of: the highly reliable and valid self-report inventories and clinical rating scales utilized; the structured, symptom-focused, and goal-directed clinical interviews conducted; and the rapport and trust established between the patients and the clinicians

OBJECTIFYING HUMAN EXPERIENCE: AN INTERPRETATION OF ERNST CASSIRER\u27S CONCEPTION OF THE SYMBOLIC FUNCTION

My aim in this dissertation is threefold. First I explore Cassirer\u27s thesis that all human expression and representation is symbolic. Human life unfolds in the interplay of physical necessity and self-determination. In life we continually integrate and balance material and non-material components. The symbolic function is the vehicle whereby we interweave these two dimensions. To accomplish this task and to show why human expression and representation is symbolic, I trace Cassirer\u27s conception of the symbolic function to Kant\u27s distinction between symbols and schemata. I then develop Cassirer\u27s deviation from Kant, which led to his own formulation of the concept of the symbolic function and his views on objectifying experience. The second aim of this work addresses the implications of the symbolic function for objectifying human experience. Though objects may indeed exist independently of us, we cannot express or represent what there is independently of our human modes of expression--our symbolic forms. Objects are never presented directly but are always known indirectly through some form of expression. This constraint stems from our nature as human subjects and is therefore subjectively necessary for objectifying human experience. This implies that truth as well as beauty cannot be addressed independently of the modality through which it is expressed and represented. Finally, I have one more aim in view. Cassirer was a cultural activist who grappled with the source of the creative human potential. Far too often in contemporary times we impose psychic and spiritual binds on ourselves that stifle our creative imagination and reduce us to the level of material objects. Cassirer speaks to the productive activity of the human imagination which can function through any modality to combat the spiritual vacuum of contemporary culture. This source of creative freedom does not hover in an abstract realm oblivious to the irrational tendencies of human beings, but is grounded in the materials of daily life. It enables us to objectify human experience through any form of expression by means of the symbolic function