Improving survey response rates from parents in school-based research using a multi-level approach

BACKGROUND: While schools can provide a comprehensive sampling frame for community-based studies of children and their families, recruitment is challenging. Multi-level approaches which engage multiple school stakeholders have been recommended but few studies have documented their effects. This paper compares the impact of a standard versus enhanced engagement approach on multiple indicators of recruitment: parent response rates, response times, reminders required and sample characteristics. METHODS: Parents and teachers were distributed a brief screening questionnaire as a first step for recruitment to a longitudinal study, with two cohorts recruited in consecutive years (cohort 1 2011, cohort 2 2012). For cohort 2, additional engagement strategies included the use of pre-notification postcards, improved study materials, and recruitment progress graphs provided to school staff. Chi-square and t-tests were used to examine cohort differences. RESULTS: Compared to cohort 1, a higher proportion of cohort 2 parents responded to the survey (76% versus 69%; p < 0.001), consented to participate (71% versus 56%; p < 0.001), agreed to teacher participation (90% versus 82%; p < 0.001) and agreed to follow-up contact (91% versus 80%; p < 0.001). Fewer cohort 2 parents required reminders (52% versus 63%; p < 0.001), and cohort 2 parents responded more promptly than cohort 1 parents (mean difference: 19.4 days, 95% CI: 18.0 to 20.9, p < 0.001). CONCLUSION: These results illustrate the value of investing in a relatively simple multi-level strategy to maximise parent response rates, and potentially reduce recruitment time and costs

An investigation of parent posttraumatic cognitions and mental health outcomes after trauma exposure in children

© 2017 Dr. Elizabeth Jane SchilpzandIntroduction: Parent posttraumatic cognitions have received little attention in the childhood posttraumatic stress literature, yet potentially play an important role in understanding how parents influence children’s recovery after trauma. The manner in which parents respond to their child’s experience is important in the development and treatment of childhood posttraumatic stress disorder (PTSD), and a range of parenting behaviours and parent psychological problems have been linked to childhood posttraumatic stress (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field, 2012; Williamson et al., 2017). To date, limited empirical attention has been given to the nature of cognitions in parents of trauma-exposed children, and the research has been restricted to the use of small item pools, as a multidimensional measure of parent posttraumatic cognitions related to the child’s recovery had yet to be operationalised. The overall aim of this program of research was to develop a measure of parent posttraumatic cognitions for use after a child has experienced a traumatic event, and to examine whether these parent cognitions related to child and parent mental health outcomes. Method: This research had two parts. In Part A, a parent-report questionnaire, the Thinking About Recovery Scale (TARS), was developed to assess specific negative posttraumatic cognitions parents may have after their child is exposed to trauma. The theoretical-rational approach to scale development was used to generate items, which were then subjected to review by experts in the field of childhood trauma. In Part B, the TARS was used in a cross-sectional study, the Thinking About Recovery Project, to examine whether parent posttraumatic cognitions were related to mental health outcomes using a sample of parents and children after children’s experience of accidental injury. Participants were 116 parents and 88 children aged 8-16 years who had been physically injured (e.g., sporting injury, burns, motor vehicle accident) and subsequently admitted to hospital for at least 24 hours. Data collection involved questionnaires to assess parent and child posttraumatic cognitions and mental health outcomes (posttraumatic stress, depression, anxiety, externalising symptoms) between 3 and 6 months post injury. Results: The development and psychometric evaluation of the TARS is reported. The 33-item scale measuring three domains (My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance) demonstrated sound internal consistency and convergent validity when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. Posttraumatic cognitions parents had about themselves, the world, and their child’s recovery were significantly associated with both parent and child posttraumatic stress symptoms (PTSS), and a range of other mental health outcomes. A range of parent posttraumatic cognitions were significantly associated with child posttraumatic cognitions. Parent cognitions related to the child mediated the relationship between parents and child PTSS. Discussion and Conclusion: This research was a necessary step in advancing knowledge about parental influences on children’s recovery from traumatic events. Findings provide an empirical basis for ongoing investigation into how parent posttraumatic cognitions may be contributing to the development and maintenance of PTSD symptomatology in parents and children, with particular consideration to cognitions parents have related to their child’s recovery

Development and Evaluation of the Thinking About Recovery Scale: Measure of Parent Posttraumatic Cognitions Following Children's Exposure to Trauma

Researchers have recently suggested that parent posttraumatic appraisals potentially contribute to the development of posttraumatic stress in both parents and children following children's exposure to trauma. However, a single-instrument, multidimensional measure of parent posttraumatic cognitions as they relate to their child's recovery has yet to be operationalized. This study described the development and evaluation of a parent-report questionnaire of parent posttraumatic cognitions, designed to be used after a child's exposure to trauma. We generated an initial pool of items in reference to existing theories and subjected this list to an iterative process of item writing and revision. Items were subjected to expert review to maximize construct validity. The 33-item Thinking About Recovery Scale (TARS), which measures three domains (My child has been permanently damaged; The world is dangerous for my child; Parents should always promote avoidance) demonstrated good internal consistency (Cronbach's α = .74-88) and convergent validity (r range = .08-.40) when piloted in a sample of 116 parents of children who had been exposed to a serious accidental injury. The TARS augments the available literature by providing a brief measure of parent posttraumatic cognitions, an area which is currently understudied in childhood posttraumatic stress and could have broad clinical and research use

Can children predict psychological recovery after injury?

While children’s voice is core to paediatric care, their own assessment of future psychological needs is underexplored. We conducted a prospective observational study among children hospitalised for injury in Melbourne, Australia. Their expectations of psychological recovery at baseline (in hospital) were significant and substantial predictors of their quality of life and post-traumatic stress 6 weeks later, suggesting potential diagnostic value

Sample characteristics of participants and non-participants in cohort 1 and cohort 2.

<p>^a Participants are parents who completed the screening survey</p><p>^<b>b</b> Socio Economic Indexes for Areas Disadvantage</p><p>Sample characteristics of participants and non-participants in cohort 1 and cohort 2.</p

Trauma exposure in children with and without ADHD: prevalence and functional impairment in a community-based study of 6–8-year-old Australian children

Both ADHD and trauma exposure are common childhood problems, but there are few empirical data regarding the association between the two conditions. The aims of this study were to compare lifetime prevalence of trauma exposure in children with and without ADHD, and to explore the association between trauma exposure and outcomes in children with ADHD. Children aged 6-8 years with ADHD (n = 179) and controls (n = 212) recruited from 43 schools were assessed for ADHD, trauma exposure and comorbid mental health disorders using the Diagnostic Interview Schedule for Children IV. Outcome data were collected by direct child assessment, parent report and teacher-report, and included ADHD symptom severity, internalizing and externalizing problems, quality of life, and academic functioning. Logistic and linear regression models were used to examine differences adjusted for child and family socio-demographics. Children with ADHD were more likely than controls to have ever experienced a traumatic event (27 vs 16%; OR: 1.99; 95% CI 1.21, 3.27). This difference remained significant in the adjusted model (OR: 1.76, 95% CI 1.03, 3.01) accounting for child factors (age and gender) and family socio-demographic factors (parent age, parent high school completion and single parent status). Among those with ADHD, trauma-exposed children had higher parent-reported ADHD severity and more externalizing problems than non-exposed children, however, this effect attenuated in adjusted model. Children with ADHD were more likely to have experienced a traumatic event than controls. The high prevalence of trauma exposure in our sample suggests that clinicians should evaluate for trauma histories in children presenting with ADHD

Response rate and sample characteristics for cohort 1 and 2.

<p>^a n = number of parents approached to participate</p><p>^b Socio Economic Indexes for Areas Disadvantage</p><p>^c ‘Response received’ includes parents who responded indicating they did not consent to participation</p><p>Note: Response rates may differ to other papers reporting on the Children’s Attention Project sample. Other papers reporting on this sample report slightly lower response rates due to exclusionary criteria applied post the return of the baseline screening surveys</p><p>Response rate and sample characteristics for cohort 1 and 2.</p

Dysfunctional posttraumatic cognitions, posttraumatic stress, and depression in children and adolescents exposed to trauma: A network analysis

Background: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. Methods: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. Results: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. Conclusions: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.</p