Pragmatic language impairment general and specific associations to mental health symptom dimensions in a child psychiatric sample

Background: The results of several international studies indicate a high prevalence of language and communication impairments among children who are referred to child psychiatric services. However, these impairments are likely to remain undetected unless language and communication impairments are evaluated during the psychiatric assessment. Aims: The aim of the present study is to investigate the specific association between general and specific mental health problems, as expressed by the problem scales of Child Behavior Checklist (CBCL) and Teachers Report Form (TRF), and pragmatic skills and pragmatic language impairments (PLI) as defined the Pragmatic Composite of the Child Communication Checklist (CCC-PC). Methods: Children aged from 8 to 13 years (n = 73) were recruited in sequence following referral to a child and adolescent psychiatry (CAMHS) outpatient clinic within 12 months. Children with possible or established autism or intellectual disability were excluded. Standardized instruments measuring language, communication and mental health symptoms were distributed to parents and teachers, an intelligence test administered for clinical purposes, and demographic information was included. Results: The parent reports showed PLI among 38% of the children and revealed strong associations with the CBCL scales for emotional problems, thought problems and, especially, social and withdrawal symptoms, which mean more associations to internalized and non-externalized problems. PC-scores were at similar levels and PLI was reported by teachers at similar rates (compared to parent reports) with moderate agreement. Teacher PC-scores showed associations to only one TRF-scale, social problems. The CCC-PC subscale with the strongest associations to mental health symptoms was «Use of Context» («Social Relationships» do not contribute to the CCC-PC scores). Conclusion: There was a general increase in PC-scores and increased prevalence of PLI in this clinical sample. PC-scores correlated with symptom scores for internalizing and non-externalizing problems scales. The strongest common factors appear to be related to the social aspects of mental health. Pragmatic skills should be considered as a protective factor for mental health rather than investigating pragmatic impairment as a risk or vulnerability factor

The Interplay of Youth and Care Characteristics with a Positive Social Climate in Therapeutic Residential Youth Care

Background: Limited research exists on how therapeutic residential youth care (TRC) achieves treatment outcomes. More specifically, little is known about the association between contextual factors such as treatment organization, youth characteristics, and experienced social climate in TRC. Therefore, this study aims to investigate differences between latent classes of TRC and youth characteristics and their association with a positive perceived social TRC climate. Method: We applied a person-centered approach in a cross-sectional design with a sample of 400 adolescents and 142 staff leaders. We analyzed youth and TRC characteristics in a latent class analysis and established associations with social climate for these two groupings. Results: The two types of TRC settings we found, i.e., larger TRC settings and family-style TRC settings, show small differences in social climate. These settings only differed on youth activities and staff shifts type (more cohabitation and unorganized activities outside TRC in family-style TRC). We identified four adolescent classes: A severe problems group, youth with incidental problems, family problems, and a migrant background group. The migrant background group showed the most positive perceptions of social climate, followed by youth with incidental problems, family problems, and severe problems. Conclusions: TRC staff should acknowledge how perceived social climate is connected to TRC characteristics and the heterogeneity of adolescents in care. As social climate is subjective and dynamic, a continuous dialogue about TRC social climate between staff and youth is recommended. Future research should investigate how these aspects are associated with treatment outcomes to increase our understanding of achieving positive outcomes in TRC

Familieambulatoriet - en vellykket modellfor identifisering av sped- og småbarn i risiko?

Studien undersøkte om en pilot-implementering av Familieambulatoriet i Norge har lyktes med å rekruttere og identifisere sped- og småbarn og deres familier med forhøyet risiko basert på dokumentasjon i sykehusjournal. Familieambulatoriet er en modell for å støtte gravide/småbarnsforeldre med rus- og psykiske problemer og tilbyr oppfølging fram til barnets skolestart. Resultatene viste signifikante forskjeller mellom brukere av Familieambulatoriet og den generelle befolkningen, og at Familieambulatoriet langt på vei rekrutterer og identifiserer gravide kvinner, sped- og småbarn i risiko for psykisk skjevutvikling, men at modellen trenger økt kvalitetssikring slik at risikofaktorer systematisk blir dokumentert

Anxiety and depressive symptoms related to parenthood in a large Norwegian community sample: the HUNT2 study

The study compared anxiety and depression prevalence between parents and non-parents in a society with family- and parenthood-friendly social politics, controlling for family status and family history, age, gender, education and social class. All participants aged 30–49 (N = 24,040) in the large, non-sampled Norwegian HUNT2 community health study completed the Hospital Anxiety and Depression Scales. The slightly elevated anxiety and depression among non-parents compared to parents in the complete sample was not confirmed as statistically significant within any subgroups. Married parents and (previously unmarried) cohabiting parents did not differ in portraying low anxiety and depression prevalence. Anxiety was associated with single parenthood, living alone or being divorced, while elevated depression was found only among those living alone. Burdening selection and cultural/political context are suggested as interpretative perspectives on the contextual and personal influences on the complex relationship between parenthood and mental health

Emotional distress and parenting among community and clinic parents

Background: The purpose of this thesis was to investigate the distribution of and the change in parental emotional distress and parenting dimensions by combining samples of community parents, non-parents and clinic parents. Clinic parents were involved in intensive inpatient family treatment related to their children’s psychiatric problems. Research questions: The focal themes of the three research questions were as follows: 1) Anxiety and depression among community parent and non-parent subgroups, 2) The stability of parenting dimensions among community parents 3) Longitudinal changes in parents related to family inpatient treatment in child psychiatry. Anxiety and depression among community parents. Overall, parenthood itself did not seem to have a primary influence on anxiety and depression in the population. In a large community health study (HUNT2) parents displayed only slightly less anxiety than nonparents, however, previous divorce and single status were found to be the risk factors for current anxiety, whereas single status was a risk factor for current depression. In the analyses, social class, education, gender and age were controlled for. Married and previously unmarried cohabiters represented the base level regarding anxiety and depression. The differences between these current results from Norway and results of previous research from the United States may be explained by the better economic conditions for families, more liberal attitudes regarding cohabitation and single parents and generous parental leave, child-care and supportive family policies. Parenting Stability: Parenting warmth was highly stable across the nine-month evaluation period, although it was not as stable as personality traits were. However, most of the observed instability in warmth originated from a small group of parents and was associated with low warmth, personality traits and experience with low maternal warmth in the parents’ own childhood. Stable low warmth was a rare occurrence. Parenting protectiveness was moderately stable, and its instability was associated with high protectiveness scores. Parenting authoritarianism was the most unstable; only one-third of parents reported the same level of authoritarianism when asked again after nine months. Longitudinal follow-up of parents in child psychiatry family inpatient clinics. Parents of children with attention, learning and developmental disorders reported significantly higher parenting warmth scores 3-month and 12-month follow-ups after treatment, compared to scores at the start of treatment, but it still remained lower than among community parents. However, normal levels of parenting warmth were reported at all points by parents of children with emotional problems, whereas no improvement was observed in parents of children with behavioral problems. Maternal anxiety and depression also improved significantly at 3-month and 12-month after treatment, yet anxiety and depression remained higher among family clinic mothers than among community mothers. Improvements in anxiety and depression were not related to child diagnostic categories. However, a reduction in parental anxiety was related to a general reduction in children’s symptoms, whereas a reduction in parental depression was related to improved parenting warmth

The Ecology of Sustainable Implementation.Reflection on a 10-Year Case History Illustration.

The primary aim of this paper is to illustrate the strategic and ecological nature of implementation. The ultimate aim of implementation is not dissemination but sustainability beyond the implementation effort. A case study is utilized to illustrate these broad and long-term perspectives of sustainable implementation based on qualitative analyses of a 10-year implementation effort. The purveyors aimed to develop selective community prevention services for children in families burdened by parental psychiatric or addictive problems. Services were gradually disseminated to 23 sites serving 40 municipalities by 2013. Up to 2013, only one site terminated services after initial implementation. Although many sites suspended services for shorter periods, services are still offered at 22 sites. This case analysis is based on project reports, user evaluations, practitioner interviews, and service statistics. The paper focuses on the analyses and strategies utilized to cope with quality decay and setbacks as well as progress and success in disseminating and sustaining the services and their quality. Low-cost multilevel strategies to implement services at the community level were organized by a prevention unit in child psychiatry, supervised by a university department (purveyors). The purveyors were also involved in national and international collaboration and development. Multilevel strategies included manualized intervention, in-practice training methods, organizational responsibility, media strategies, service evaluation, staff motivation maintenance, quality assurance, and proposals for new law regulations. These case history aspects will be discussed in relation to the implementation literature, focusing on possible applicability across settings

Change in mental health symptoms in families with nonresponding children referred to inpatient family units

Aims: To examine changes in child mental health symptoms following inpatient family unit treatment after long-term unsuccessful treatment in community and child psychiatry outpatient services. Follow-up from referral and admission to 3 and 12 months. Methods: Standardized questionnaires measuring the child mental health symptoms and parental anxiety and depression converted to standardized scores and compared to each child’s clinical diagnosis. Results: Significant group mean improvement on almost all problem scales at the 3-month follow-up (T2) remaining through 12-month follow-up (T3) relative to admission (T1). Aggression showed the highest levels and largest improvements. Statistically significant improvements were widespread, whereas clinically significant improvements were found for some diagnostic groups on diagnosis-related problems and secondary problems. Improvement in child symptoms were partly correlated with improvement in parental anxiety symptoms. Implications: Even previously nonresponding children may benefit from broad tailored interventions including parents and the wider system. Development of systematic component approaches is needed

Change in mental health symptoms in families with nonresponding children referred to inpatient family units

Aims: To examine changes in child mental health symptoms following inpatient family unit treatment after long-term unsuccessful treatment in community and child psychiatry outpatient services. Follow-up from referral and admission to 3 and 12 months. Methods: Standardized questionnaires measuring the child mental health symptoms and parental anxiety and depression converted to standardized scores and compared to each child’s clinical diagnosis. Results: Significant group mean improvement on almost all problem scales at the 3-month follow-up (T2) remaining through 12-month follow-up (T3) relative to admission (T1). Aggression showed the highest levels and largest improvements. Statistically significant improvements were widespread, whereas clinically significant improvements were found for some diagnostic groups on diagnosis-related problems and secondary problems. Improvement in child symptoms were partly correlated with improvement in parental anxiety symptoms. Implications: Even previously nonresponding children may benefit from broad tailored interventions including parents and the wider system. Development of systematic component approaches is needed.publishedVersion© The Author(s) 201

The Ecology of Sustainable Implementation.Reflection on a 10-Year Case History Illustration.

The primary aim of this paper is to illustrate the strategic and ecological nature of implementation. The ultimate aim of implementation is not dissemination but sustainability beyond the implementation effort. A case study is utilized to illustrate these broad and long-term perspectives of sustainable implementation based on qualitative analyses of a 10-year implementation effort. The purveyors aimed to develop selective community prevention services for children in families burdened by parental psychiatric or addictive problems. Services were gradually disseminated to 23 sites serving 40 municipalities by 2013. Up to 2013, only one site terminated services after initial implementation. Although many sites suspended services for shorter periods, services are still offered at 22 sites. This case analysis is based on project reports, user evaluations, practitioner interviews, and service statistics. The paper focuses on the analyses and strategies utilized to cope with quality decay and setbacks as well as progress and success in disseminating and sustaining the services and their quality. Low-cost multilevel strategies to implement services at the community level were organized by a prevention unit in child psychiatry, supervised by a university department (purveyors). The purveyors were also involved in national and international collaboration and development. Multilevel strategies included manualized intervention, in-practice training methods, organizational responsibility, media strategies, service evaluation, staff motivation maintenance, quality assurance, and proposals for new law regulations. These case history aspects will be discussed in relation to the implementation literature, focusing on possible applicability across settings.Creative Commons Attribution-Noncommercial License Version 3.0

Situational Consultation

Situational Consultation (SC) is presented as a framework for flexible integration of several models and methodologies in consultation practice by choosing an approach adapted to the specific situation. In SC, models and their characteristic role positions are considered interchangeable tools with qualitative differences in strengths and applicability depending on the situational context. Three ideal-type positions in consultation—the advisory, the hermeneutic, and the reflective positions—are used as analytic concepts to guide adaptations of consultation to context and process. Principles developed in a consultation practice that attempts to implement such strategic flexibility are described with illustrative examples of SC applied in practice.<p>To cite this article: Tormod Rimehaug &amp; Ingunn Helmersberg (2010) Situational Consultation, Journal of Educational and Psychological Consultation, 20:3, 185-208, DOI:10.1080/10474412.2010.500509</p><p>To link to this article: http://dx.doi.org/10.1080/10474412.2010.500509</p