Psychological correlates of mental health outcomes in looked after preschool children

Background: Children who enter foster care usually do so because of maltreatment by their birth families. Early adversity such as this is associated with many negative outcomes, including disturbances of attachment and mental health in childhood and throughout the lifespan. Young children (under 5) are particularly at risk due to maltreatment rates being highest in this age range, and because of the vital brain development that occurs during this time. Improving the quality of existing relationships for young children is the most cost effective way to improve mental health outcomes. It is important that research investigates which relational and psychological variables that exist within the foster carer-child relationship may be protective against developing negative mental health outcomes, so as to inform carer training and future interventions for this vulnerable group. Aims: The aims of this research project were twofold. The first aim was to systematically review the existing literature on links between foster carer psychological variables (such as commitment to their foster child), and/or child psychological variables (such as their attachment style), and the mental health outcomes of children in foster care. The second aim was to investigate whether foster carer acceptance, commitment, awareness of influence and reflective functioning (RF) predict the mental health outcomes of Scottish preschool aged children who are looked after in foster care. Method: A systematic review of the existing literature was undertaken to address the first aim. The search strategy resulted in 12 quantitative studies that investigated links between child or carer psychological variables and child mental health outcomes. An empirical study of 179 pre-school aged children in foster care in Scotland was carried out to address the second aim. Participants were taking part in a wider RCT of a novel intervention to improve outcomes and permanency decisions for children in foster care. Foster carer acceptance, commitment, and awareness of influence was assessed using the This Is My Baby Interview, and scores of RF were coded from the transcripts of this interview using a computer-based algorithm. Child mental health information was gathered using the Infant Toddler Social Emotional Assessment. Data was gathered at 2 time points; baseline assessments occurred around 4 weeks after entry to care, and follow-up assessments were carried out a year later. Results: The systematic review found good evidence that foster child attachment security is linked to more positive mental health outcomes. It also found some evidence suggesting that foster carer psychological variables such as commitment and quality of caregiving also relate to child mental health outcomes, but this research is in its infancy and it is therefore difficult to draw firm conclusions around this. The results of the empirical study showed that carer commitment and awareness of influence predict child competence at baseline, and RF predicts internalising and externalising problems at follow up. No predictive relationships were found between carer variables and child mental health over time. Conclusion: The results from both studies suggest that carer psychological variables such as commitment to their foster child may relate to child mental health development. These results have implications in terms of foster carer training, and for intervention development for this vulnerable population. This research is however in its infancy, and the results suggest a complex picture with regard to carer psychological variables and child mental health. Large-scale high quality longitudinal research is needed to provide a clear understanding of these relationships

Efficacy of Mentalization-Based Group Therapy for adolescents:A pilot randomised controlled trail

oai:ojs.pkp.sfu.ca:article/2647Background: Suicide is the leading cause of death in adolescents. Furthermore, up to one quarter of adolescents who self-harm will repeat self-harm within one year, highlighting the need for evidence-based prevention and treatment services. Mentalization Based Therapy (MBT) has yielded promising outcomes for individuals who self-harm, however to date only one study has examined MBT in adolescents, wherein the treatment protocol consisted of individual and family therapy. Currently, there has been no development or examination of MBT-A in a group format for adolescents. Methods/Design: The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Participants are adolescents presenting to Child and Adolescent Mental Health Services (CAMHS) with self-harming behaviors within the last 6 months. Young people will be randomised to a 12-week MBT-Ai group plus treatment as usual (TAU) or TAU alone. Participants will be assessed at baseline and at 12-, 24- and 36-weeks post-baseline. Discussion: This paper describes the development of a treatment manual and the protocol of a randomised controlled feasibility trial of MBT-Ai aimed at treating adolescents who self-harm. Further investigation of a full-scale trial will be necessary to instill benefits if pilot results suggest efficacy. Trial registration: NCT0277169

Neurodevelopmental problems in maltreated children referred with indiscriminate friendliness

We aimed to explore the extent of neurodevelopmental difficulties in severely maltreated adopted children. We recruited 34 adopted children, referred with symptoms of indiscriminate friendliness and a history of severe maltreatment in their early childhood and 32 typically developing comparison children without such a history, living in biological families. All 66 children, aged 5–12 years, underwent a detailed neuropsychiatric assessment. The overwhelming majority of the adopted/indiscriminately friendly group had a range of psychiatric diagnoses, including Attention Deficit Hyperactivity Disorder (ADHD), Post-Traumatic Stress Disorder (PTSD) and Reactive Attachment Disorder (RAD) and one third exhibited the disorganised pattern of attachment. The mean IQ was 15 points lower than the comparison group and the majority of the adopted group had suspected language disorder and/or delay. Our findings show that school-aged adopted children with a history of severe maltreatment can have very complex and sometimes disabling neuropsychiatric prob

Efficacy of Mentalization-based group therapy for adolescents: the results of a pilot randomised controlled trial

Background: Mentalization Based Therapy (MBT) has yielded promising outcomes for reducing self-harm, although to date only one study has reported MBT's effectiveness for adolescents (Rossouw and Fonagy, J Am Acad Child Adolesc Psychiatry 51:1304-1313, 2012) wherein the treatment protocol consisted of an intensive programme of individual and family therapy. We sought to investigate an adaptation of the adult MBT introductory manual in a group format for adolescents. Methods: The present study is a randomised controlled single blind feasibility trial that aims to (1) adapt the original explicit MBT introductory group manual for an adolescent population (MBT-Ai) and to (2) assess the feasibility of a trial of MBT-Ai through examination of consent rates, attendance, attrition and self-harm. Repeated measures ANOVAs were conducted to examine change over time in independent and dependent variables between groups, and multi level models (MLM) were conducted to examine key predictors in relation to change over time with self-report self-harm and emergency department presentation for harm as the primary outcome variables. Results: Fifty-three young people consented to participate and were randomised to MBT-Ai + TAU or TAU alone. Five participants withdrew from the trial. Trial procedures seemed appropriate and safe, with acceptable group attendance. Self-reported self-harm and emergency department presentation for self-harm significantly decreased over time in both groups, though there were no between group differences. Social anxiety, emotion regulation, and borderline traits also significantly decreased over time in both groups. Mentalization emerged as a significant predictor of change over time in self reported self harm and hospital presentation for self-harm. Conclusions: It was feasible to carry out an RCT of MBT-Ai for adolescents already attending NHS CAMHS who have recently self-harmed. Our data gave signals that suggested a relatively brief group-based MBT-Ai intervention may be a promising intervention with potential for service implementation. Future research should consider the appropriate format, dosage and intensity of MBT for the adolescent population

Treatment effectiveness and efficiency following routine structured feedback on patient progress in individual psychological therapy in mental health settings: protocol for a systematic review

A systematic review looking at the effects of structured routine feedback in individual psychological therapy on treatment effectiveness and efficiency in mental health/psychiatric setting

Langzeitverhalten biologisch schnell abbaubarer Schmieroele. T. 2 Abschlussbericht

SIGLEAvailable from TIB Hannover: F96B1057+a / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekBundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie, Bonn (Germany)DEGerman